ASCO GU 2022: First-Line Therapy for Metastatic Renal Cell Carcinoma With Pancreatic Metastases: Results From the IMDC

(UroToday.com) The 2022 GU ASCO Annual meeting included a renal cell carcinoma (RCC) session highlighting work from Dr. Eduard Roussel and investigators presenting results of first-line therapy for metastatic RCC with pancreatic metastases from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). Metastatic RCC with pancreatic metastases is characterized by heightened angiogenesis, which is associated with improved outcomes with vascular endothelial growth factor (VEGF) inhibitors. This study aimed to compare the efficacy of first-line ipilimumab/nivolumab vs. anti-PD(L)1/anti-VEGF vs. VEGF monotherapy in metastatic RCC patients with and without pancreatic metastases.

 This study was a retrospective analysis of patients with and without pancreatic metastases using the IMDC. Sites of metastases were captured at the initiation of first-line therapy. Patients with pancreatic metastases could also have metastases at other sites. Overall survival (OS) from start of first-line therapy was assessed using Cox regression analysis, adjusted for IMDC risk groups.

 In this cohort, 543 of 7,634 (7%) patients had pancreatic metastases. Patients with pancreatic metastases in the overall population had improved OS compared to those without: 56 months vs 25.6 months, respectively (HR 0.63, 95% CI 0.55-0.73).

When examining the effect of pancreatic metastases within first-line options, those treated with anti-PD(L)1/anti-VEGF exhibited a longer OS if pancreatic metastases were present vs absent: median not reached vs 45 months, respectively (HR 0.41, 95% CI 0.18-0.93). This association was also seen in patients with treated with first-line VEGF monotherapy, in those with pancreatic metastases vs absent: median 53.1 months vs 25.1 months respectively (HR 0.65, 95% CI 0.55-0.76). However, there was no difference in median OS of patients with or without pancreatic metastases in patients receiving ipilimumab/nivolumab: 41.4 vs 44.4 months respectively (HR 0.86, 95% CI 0.48-1.56):

 

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Comparing the outcomes between first-line therapies in patients with pancreatic metastases the median OS of anti-PD(L)1/anti-VEGF vs VEGF monotherapy was not reached vs 53.1 months respectively (HR 0.37, 95% CI 0.16-0.83). Upfront VEGF monotherapy and ipilimumab/nivolumab had a similar median OS of 53.1 vs 41.4 months, respectively (HR 0.81, 95% CI 0.45-1.47). There was no difference in OS between those treated with anti-PD(L)1/anti-VEGF vs ipilimumab/nivolumab: median not reached vs 41.4 months, respectively (HR 0.52 95%, CI 0.19-1.45), but the low event rate limited this analysis:

 

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Dr. Roussel concluded his presentation assessing first-line therapy for metastatic RCC with pancreatic metastases from the IMDC with the following take-away points:

  • The presence of pancreatic metastases leads to an indolent biological behavior and was associated with improved outcomes when first-line therapy included a VEGF monotherapy component
  • Pancreatic metastases patients had comparable OS outcomes on first-line VEGF monotherapy and first-line ipilimumab/nivolumab therapy but improved OS when treated with first-line anti-PD(L)1/anti-VEGF
  • Anti-angiogenic therapy may be necessary to optimize outcomes in pancreatic metastases and this warrants prospective evaluation

 

Presented By: Eduard Roussel, MD, Department of Urology- UKLeuven, Brussels

Co-Authors: Lisa Kinget, Benoit Beuselinck, Maarten Albersen, Connor Wells, Matthew Scott Ernst, Frede Donskov, Andrew Lachlan Schmidt, Bernadett Szabados, Sumanta K. Pal, Luis A Meza, Neeraj Agarwal, Andrew James Weickhardt, Ian D. Davis, Ajjai Shivaram Alva, Lori Wood, Camillo Porta, Toni Choueiri, Daniel Yick Chin Heng, Vishal Navani

Affiliations: Belgium, University Hospitals Leuven, Leuven, Belgium, Leuven Cancer Institute, Universitaire Ziekenhuizen, Leuven, Belgium, UZ Leuven, Leuven, Belgium, BC Cancer Agency, Vancouver, BC, Canada, Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada, Aarhus University Hospital, Aarhus, Denmark, The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, Barts Cancer Institute, London, United Kingdom, Department of Medical Oncology & Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, City of Hope Comprehensive Cancer Center, Duarte, CA, Huntsman Cancer Institute, University of Utah, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Melbourne, Australia, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia, University of Michigan Rogel Cancer Center, Ann Arbor, MI, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada, University of Bari 'A. Moro' and Policlinico Consorziale di Bari, Bari, Italy, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School

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 Genitourinary (ASCO GU) Cancers Symposium, Thursday Feb 17 – Saturday Feb 19, 2022

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