(UroToday.com) The 2023 AUA annual meeting included an advanced kidney cancer session, featuring a presentation by Dr. Carlos Riveros discussing real-world survival outcomes associated with immunotherapy, targeted therapy, and combination therapy for metastatic papillary renal cell carcinoma (RCC). Much of the data used to advise patients with metastatic papillary RCC is derived from studies in the setting of metastatic clear cell RCC. The current standard of care for patients with metastatic clear cell RCC is immunotherapy with or without targeted therapy. Except for a few phase II randomized clinical trials, the benefit of immunotherapy or immunotherapy + targeted therapy combination has not been thoroughly explored in metastatic papillary RCC. As such, Dr. Riveros and colleagues sought to describe real-world utilization trends of targeted therapy, immunotherapy, and immunotherapy + targeted therapy and their impact on overall survival in the setting of metastatic papillary RCC with or without cytoreductive nephrectomy.
This study included a query of the National Cancer Database (NCDB) to identify adult patients with de novo metastatic papillary RCC who had received first-line targeted therapy, immunotherapy, or immunotherapy + targeted therapy. The primary outcomes of interest were trends in systemic therapy utilization and overall survival benefit. They then performed multivariable Cox proportional hazards regression analysis to evaluate the association between the type of systemic therapy and overall survival, after adjusting for receipt of cytoreductive nephrectomy and other covariates.
A total of 737 patients with metastatic papillary RCC were identified:
- 512 (69.5%) had received targeted therapy
- 126 (17.1%) had received immunotherapy
- 99 (13.4%) had received immunotherapy + targeted therapy
The proportion of patients who received immunotherapy and immunotherapy + targeted therapy increased steadily during the study period:
After adjusting for baseline differences, cytoreductive nephrectomy was associated with a benefit in overall survival (HR 0.63, 95% CI 0.48-0.84). However, neither immunotherapy (HR 1.10; 95% CI 0.81-1.49) nor immunotherapy + targeted therapy (HR 0.83, 95% CI 0.57-1.19) were associated with better overall survival compared to targeted therapy alone. The Kaplan-Meier survival estimates stratified by treatment received is as follows:
Dr. Riveros concluded his presentation discussing real-world survival outcomes associated with immunotherapy, targeted therapy, and combination therapy for metastatic papillary RCC by highlighting that for these patients, neither immunotherapy or immunotherapy + targeted therapy was associated with an improvement in overall survival, compared to targeted therapy alone.
Presented by: Carlos Riveros, MD, Houston Methodist Hospital, Houston, TX
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 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023