EIKCS 2022: ‘Real World’ Impact of Immune Checkpoint Inhibitors on Survival in Metastatic Renal Cell Carcinoma

(UroToday.com) The 2022 International Kidney Cancer Symposium (IKCS) European Annual meeting included an oral abstract session and presentation by Dr. Will Ince discussing the real world impact of immune checkpoint inhibitors on survival in metastatic RCC. Real world evidence is important given that few patients are able to enroll in clinical trials, thus assessing these outcomes provides a pragmatic evaluation of utilization across the community. For this study, Dr. Ince and colleagues queried an electronic health record metastatic RCC database at their institution from January 2012 through July 2020, comparing survival among patients that received immune checkpoint inhibitors vs those patients that did not receive immune checkpoint inhibitors. Key data collected included lines of treatment, survival, age, ECOG status, and IMDC criteria.

There were 423 patients that received one or more lines of treatment included in the study, of which 296 were deceased and 127 were censored. The Kaplan-Meier method was used to assess overall survival, which was defined as the time from the start of first-line treatment to death. Multivariable Cox proportional hazards regression models were performed adjusting for immune checkpoint inhibitor therapy (yes vs no), age, ECOG, IMDC criteria, and gender. Sensitivity analyses were performed for patients that received treatment from 2016 onwards, which was the year of the first immune checkpoint inhibitor therapy approval in the UK (second-line nivolumab).

Overall, 71.5% of patients were treated and 28.5% of patients were not treated in this cohort. 

With regards to immune checkpoint inhibitors, 32.6% of patients received treatment, whereas 67.4% of patients did not receive immune checkpoint inhibitors. The majority of immune checkpoint inhibitor treatments occurred in first and second line, as highlighted in the following figure:

Metastatic Renal Cell Carcinoma-1.jpg

Patients that received immune checkpoint inhibitors were younger (median 63.9 years vs 66.7 years, p = 0.013), more likely to have an ECOG score of 0-1 (91% vs 72%, p < 0.001), and more likely to have IMDC favorable risk disease (23% vs 11%, p = 0.003) compared to those patients not treated with immune checkpoint inhibitors. Treatment with immune checkpoint inhibitors from 2012-2020 was associated with a median overall survival of 34.2 months (95% CI 28.7 – 46.7) vs 11.3 months (95% CI 9.0 – 15.1) for those not treated with immune checkpoint inhibitors (HR 0.45, 95% CI 0.34 – 0.59). 

When restricted to patients treated from 2016 to 2020, there was a similar benefit to treatment with immune checkpoint inhibitors: median overall was 28.7 months (95% CI 21.7 – 39.9) vs 11.0 months (95% CI 8.7 – 16.9); HR 0.53 (95% CI 0.37 – 0.75).

The type of agent used stratified by line of treatment is as follows:

Metastatic Renal Cell Carcinoma-4.jpg

Dr. Ince concluded his presentation by discussing the real world impact of immune checkpoint inhibitors on survival in metastatic RCC noting that this study provides important real world evidence with of utilization of immune checkpoint inhibitors to complement the knowledge basis provided in the previously published phase 3 clinical trials.

Presented by: Will Ince, FRCR, MRCP, MRCGP, MB BS, Department of Oncology, Cambridge University NHS Foundation Trust, Cambridge, United Kingdom

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 International Kidney Cancer Symposium (IKCS) Europe Annual Hybrid Meeting, Antwerp, Belgium, Fri, Apr 22 – Sun, Apr 24, 2022.