ASCO GU 2018: Outcomes and Patterns of Disease Progression in Metastatic Renal Cell Carcinoma Patients Treated with Nivolumab

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Nivolumab (nivo) has been approved for the treatment of refractory metastatic renal cell carcinoma (mRCC). Data regarding the characteristics and outcomes of patients who progress on nivo are lacking.

The authors conducted a retrospective analysis of patients with clear cell mRCC who received nivo at Cleveland Clinic (2015-2017). Patients were divided into two groups:

1) Progressive disease (PD) group per RECIST v1.1 criteria or clinical PD 

2) Non progressive disease (NPD) group

Ninety patients (PD group n = 56, NPD group n = 34) with median age of 67 (33-83), 74% men, and 79% ECOG 0-1 were included. Patients had received 1 (44%), 2 (29%), or ≥ 3 (27%) prior systemic treatments, most commonly with sunitinib (71%), axitinib (39%) and pazopanib (33%). Patients in the PD group had a greater incidence of baseline liver metastases (PD, 40% vs. NPD, 14%; p = 0.01), with other baseline characteristics not significantly different. Median follow up was similar in both groups (PD group, 8.0 months (95% CI, 5.5-10.5) and NPD group, 7.1 months (95% CI, 4.9-9.3); p = 0.87). Median duration of treatment for PD group was 8.7 months (95% CI, 7.3-10.1) compared to 16.1 months (95% CI, 8.6-23.6) for NPD group (p = 0.02). In the PD group, 50 (91%) patients developed PD per RECIST v1.1 whereas 5 (9%) patients had clinical PD. 

New organ sites of metastases were found in 20/55 (36%) patients; brain (8/20; 40%), liver (4/20; 20%), soft tissue (4/20; 20%), and locoregional metastasis (4/20; 20%) were the most common new organ sites, whereas lungs, lymph nodes and pancreas were never involved at PD as new organ sites. Twelve patients received treatment beyond progression with a median duration of 2.8 months (95% CI, 0.6-5.0) and 50% of patients had stable disease as their best response. Median overall survival (OS) and progression free survival (PFS) on nivo were 10.1 months (95% CI, 6.6-13.6) and 5.5 months (95% CI, 2.9-8.1), respectively.

Patients with PD on nivo have a higher incidence of hepatic metastases at baseline, and one third of these patients develop new sites of metastases at PD, most commonly in the brain.

Presented by: Haris Zahoor, Cleveland Clinic, Cleveland, OH, USA

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