ASCO GU 2018: Outcomes of Patients with Metastatic Clear-Cell RCC Treated with Second-Line VEGFR-TKI After First-Line Immune Checkpoint Inhibitors

San Francisco, CA ( Dr. Amishi Shah from the MD Anderson Cancer Center provided an analysis of outcomes of patients with metastatic clear cell RCC treated with second line VEGF-TKI after first line immune checkpoint inhibitors. There is a paucity of data that exists on objective response rates (ORR), progression-free survival (PFS), and safety of second-line VEGFR-TKI after first-line immune checkpoint inhibitor therapy in patients with metastatic clear-cell RCC. The objective of this study was to evaluate the above mentioned clinical endpoints. 

The authors performed a retrospective assessment of their institutional database, identifying 43 patients fulfilling inclusion criteria. Tumor response was assessed by a blinded radiologist using RECIST 1.1. Descriptive statistics, the Fisher’s test, and Kaplan-Meier method were used.

The characteristics of the patients included in this cohort are as follows: 
Abstract682 1

The median age at metastatic clear cell RCC diagnosis was 59 years (range: 43-72), 33 patients had lung metastasis, 20 had lymph node metastasis, 14 had bone metastasis, and 3 had liver metastasis. As first-line therapy, 20 patients (47%) received nivolumab + ipilimumab, 14 (33%) received nivolumab + bevacizumab, and 9 (21%) received nivolumab. Median time on immune checkpoint inhibitor therapy was 29.4 weeks. A summary of outcomes with several stratifications is as follows:
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One patient (2%) had complete response, 17 patients (40%) had partial response, and 25 patients (58%) had stable disease, leading to 100% disease control rate (DCR) as best response to second-line VEGFR-TKI. Median PFS was 10.0 months (95%CI 7.4, NR), and estimated 1-yr overall survival (OS) was 87.5% (95%CI 74.6-100). Seven patients (16%) discontinued VEGFR-TKI therapy because of adverse events: Grade 3 transaminitis (three on pazopanib), Grade 3 hand-foot skin reaction (one on axitinib), impaired wound healing (one on axitinib), and Grade 3 pancreatitis (one on pazopanib, one on axitinib).

The authors concluded that in this retrospective study, there was a 42% ORR, a 10-month median PFS, and a 100% DCR in patients with metastatic clear cell RCC who received VEGFR-TKI after progressive disease with immune checkpoint inhibitor. These results may inform the design of trials with second-line VEGFR-TKI after failure of immune checkpoint inhibitor therapy.

Presented by: Amishi Yogesh Shah, MD, MD Anderson Cancer Center, Houston, TX

Co-Authors: Emily Lemke, Jianjun Gao, Anuradha Chandramohan, Matthew T. Campbell, Amado J. Zurita, Lianchun Xiao, Jennifer Wang, Paul Gettys Corn, Eric Jonasch, Padmanee Sharma, Nizar M. Tannir; UT MD Anderson Cancer Center, Houston, TX

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA