ESMO 2021: Matching-Adjusted Indirect Comparison of Health-Related Quality of Life of Nivolumab plus Cabozantinib Versus Pembrolizumab plus Axitinib in Previously Untreated Advanced RCC

( The European Society of Medical Oncology (ESMO) 2021 annual meeting’s non-prostate cancer session included a presentation by Dr. Camillo Porta discussing results of a comparison of health-related quality of life of nivolumab plus cabozantinib versus pembrolizumab plus axitinib in previously untreated advanced RCC. The landscape for first-line advanced RCC is rapidly evolving, with pembrolizumab plus axitinib and nivolumab plus cabozantinib recommended as standard of care irrespective of risk group by the European Association of Urology and the European Society for Medical Oncology. Pembrolizumab plus axitinib and nivolumab plus cabozantinib have similar modes of action and demonstrated a significant efficacy benefit versus sunitinib, although no head-to-head data exist. As advanced RCC significantly impacts health-related quality of life, understanding health-related quality of life benefits of these two treatments is of interest to inform clinical decision making. The objective of this study was to understand the comparative health-related quality of life benefits of nivolumab plus cabozantinib versus pembrolizumab plus axitinib in patients with previously untreated advanced RCC.

An anchored matching-adjusted indirect comparison was conducted using patient-level data from the CheckMate 9ER trial (NCT03141177; nivolumab plus cabozantinib vs sunitinib1) and aggregate published data from the KEYNOTE-426 trial (NCT02853331; pembrolizumab plus axitinib vs sunitinib2). As follows is a summary of these two studies’ characteristics:


Outcomes included Functional Assessment of Cancer Therapy Kidney Cancer Symptom Index – Disease-Related Symptoms (FKSI-DRS) and EQ-5D visual analog scale (EQ-VAS) due to limited published health-related quality of life data from KEYNOTE-426. Hazard ratios for time to first and confirmed deteriorations and baseline to week 30 least-squares mean differences in these outcomes were re-estimated for CheckMate 9ER using a weighted population and indirectly compared with those in KEYNOTE-426 via a Bayesian framework.

 A total of 651 CheckMate 9ER patients were matched to 861 KEYNOTE-426 patients using age, region, risk group, sites of metastatic disease, and prior nephrectomy. Results from the matching-adjusted indirect comparison favored nivolumab plus cabozantinib versus pembrolizumab plus axitinib in all outcomes with statistically significant differences for FKSI-DRS and time to first deterioration in EQ-VAS score:


Dr. Porta concluded his presentation comparing nivolumab plus cabozantinib versus pembrolizumab plus axitinib with the following summary statements: 

  • In patients with first-line advanced RCC, matching-adjusted indirect comparison analyses indicate that compared with pembrolizumab plus axitinib, nivolumab plus cabozantinib demonstrated a significant improvement in disease-related symptoms and significantly delayed deterioration in health-related quality of life
  • These results, combined with the efficacy and favorable safety profile of nivolumab plus cabozantinib, may further inform treatment decisions of clinicians and pts with first-line advanced RCC


Presented by: Camillo Porta, MD, Department of Internal Medicine, University of Pavia, Pavia, Italy

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 2021 European Society for Medical Oncology (ESMO) Annual Congress 2021, Thursday, Sep 16, 2021 – Tuesday, Sep 21, 2021.


  1. Choueiri TK, Powles T, Burotto M, et al. Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2021 Mar 4;384(9):829-841.
  2. Rini BI, Plimack ER, Stus V, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med 2019;380(12):1116-1127.