ASCO 2022: Distinct Outcomes in Hispanic/Latinx and Non-Hispanic/Latinx Patients With Metastatic RCC Treated With First-Line Ipilimumab + Nivolumab

(UroToday.com) The 2022 ASCO annual meeting featured a session on kidney and bladder cancer, including a presentation by Dr. Sana Ali discussing outcomes in Hispanic/Latinx and non-Hispanic/Latinx patients with metastatic renal cell carcinoma (RCC) treated with first-line ipilimumab + nivolumab. Subgroup analyses have reported differences in clinical outcomes by ethnicity in patients receiving immune checkpoint inhibitors.1 As such, Dr. Ali and colleagues sought to compare real-world outcomes between Hispanic/Latinx and non-Hispanic/Latinx mRCC patients treated with first-line ipilimumab + nivolumab within a safety-net healthcare system and at a tertiary care center in Southern California.

 This was a retrospective analysis of mRCC patients who received ipilimumab + nivolumab within the Los Angeles County Department of Health Services (a safety-net healthcare system) and the City of Hope Comprehensive Cancer Center (a tertiary oncology center) between January 1, 2015 and December 31, 2021. Patients were identified using institutional databases and clinical data were compiled from electronic health records. Patients with pathologic diagnosis of stage IV mRCC, age > 18 years and receipt of ipilimumab + nivolumab as first-line therapy were included. Progression-free survival (PFS) was analyzed using the Kaplan-Meier method and covariates were adjusted using multivariate Cox proportional hazards regression.

 Among 95 patients, 66 (69%) were male, 90 (95%) had clear-cell histology, and 88 (93%) had intermediate/poor IMDC risk. There were 41 patients (43%) that were Hispanic/Latinx, while the remainder were non-Hispanic/Latinx (44 patients [46%] White, 7 patients [7%] Asian, and 3 patients [3%] Other). Fifty (52%) and 46 (48%) patients received their care at a tertiary care center and within a safety-net healthcare system, respectively. Median age, IMDC risk classification, BMI, and number of comorbidities were similar between both groups:

 

ASCO 2022_Sana Ali_0 

 

Pooled analysis by ethnicity revealed significantly shorter PFS in Hispanic/Latinx vs non-Hispanic/Latinx patients (HR 1.60, 95% CI 1.04-2.48, p = 0.03):

 

ASCO 2022_Sana Ali_1 

 

At 12 months, 19% of Hispanic/Latinx patients (95% CI, 9-32) and 35% of non-Hispanic/Latinx patients (95% CI, 23-48) were alive and progression-free. There was no difference in PFS between patients at the safety-net hospital system vs tertiary care center (HR 1.32, 95% CI 0.87-2.02, p = 0.19):

 

ASCO 2022_Sana Ali_2 

 

Dr. Sana Ali concluded this presentation by discussing outcomes in Hispanic/Latinx and non-Hispanic/Latinx patients with metastatic RCC treated with first-line ipilimumab + nivolumab with the following take-home messages:

  • This real-world analysis of mRCC patients demonstrated poorer outcomes with ipilimumab + nivolumab in Hispanic/Latinx patients
  • Ongoing work is interrogating multiple social determinants of health that may contribute to these concerning disparities

 

Presented by: Sana Ali, MD, Harbor-UCLA Medical Center, Torrance, CA

Co-Authors: Sally Leong, Luis A Meza, Nazli Dizman, Zeynep Busra Zengin, Tane Kim, Youngju Pak, Mykola Onyshchenko, Sumanta K. Pal, Alex Chehrazi-Raffle

Affiliations: City of Hope Comprehensive Cancer Center, Duarte, CA, The Lundquist Research Institute, Torrance, CA, Harbor-UCLA Medical Center at UCLA David Geffen School of Medicine, Los Angeles, CA, Department of Medical Oncology & Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, City of Hope National Medical Center, Duarte, CA

 

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, IL, Fri, June 3 – Mon, June 7, 2022.

 

References:

  1. Peravali M, Gomes-Lima C, Tefera E, et al. Racial disparities in immune-related adverse events of immune checkpoint inhibitors and association with survival based on clinical and biochemical responses. World J Clin Oncol. 2021 Feb 24;12(2):103-114.