Atezolizumab plus Bevacizumab Versus Sunitinib for Patients with Untreated Metastatic Renal Cell Carcinoma and Sarcomatoid Features: A Prespecified Subgroup Analysis of the IMmotion151 Clinical Trial.

Patients with metastatic renal cell carcinoma with sarcomatoid features (sRCC) have a poor prognosis and have shown limited responsiveness to inhibition of the VEGF pathway. We conducted a prespecified analysis of the randomised, phase 3 IMmotion151 trial in previously untreated patients with advanced or metastatic RCC to assess the effectiveness of atezolizumab + bevacizumab versus sunitinib in a subgroup of patients with sarcomatoid features. Patients whose tumour had any component of sarcomatoid features were included and received atezolizumab + bevacizumab (n = 68) or sunitinib (n = 74). Baseline characteristics were similar between the groups. Median progression-free survival was significantly longer in the group receiving atezolizumab + bevacizumab overall (8.3 vs 5.3 mo; hazard ratio [HR] 0.52 95% confidence interval [CI] 0.34-0.79) and in the subset of patients with PD-L1-positive tumours (8.6 vs 5.6 mo; HR 0.45, 95% CI 0.26-0.77). More patients receiving atezolizumab + bevacizumab achieved an objective response (49% vs 14%), including complete responses (10% vs 3%), and reported greater symptom improvements versus sunitinib. Safety was consistent with the known profiles of each drug and with that reported in the overall safety-evaluable population of IMmotion151. This analysis supports enhanced activity of atezolizumab + bevacizumab in patients with sRCC. PATIENT SUMMARY: In this report, we looked at patients with a specific type of kidney cancer (tumours with sarcomatoid features) that has been hard to treat. A treatment with two drugs (atezolizumab and bevacizumab) appeared to help patients live longer without the disease getting worse than another drug (sunitinib) that is often used. Patients who took the two drugs also said they were better able to carry out their everyday activities than patients who took sunitinib. The combination of these two drugs may work better in patients with this type of advanced kidney cancer.

European urology. 2020 Jul 09 [Epub ahead of print]

Brian I Rini, Robert J Motzer, Thomas Powles, David F McDermott, Bernard Escudier, Frede Donskov, Robert Hawkins, Sergio Bracarda, Jens Bedke, Ugo De Giorgi, Camillo Porta, Alain Ravaud, Francis Parnis, Enrique Grande, Wei Zhang, Mahrukh Huseni, Susheela Carroll, Roxana Sufan, Christina Schiff, Michael B Atkins

Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: ., Memorial Sloan Kettering Cancer Center, New York, NY, USA., Barts Cancer Institute and the Royal Free Hospital, Queen Mary University of London, London, UK., Beth Israel Deaconess Medical Center, Boston, MA, USA., Gustave Roussy, Villejuif, France., Aarhus University Hospital, Aarhus, Denmark., The Christie NHS Foundation Trust, Manchester, UK., Azienda Ospedaliera S. Maria, Terni, Italy., University of Tübingen, Tübingen, Germany., Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy., IRCCS San Matteo University Hospital Foundation, Pavia, Italy., CHU Hopitaux de Bordeaux - Hôpital Saint-André, Bordeaux, France., Ashford Cancer Centre Research, Kurralta Park, SA, Australia., MD Anderson Cancer Center Madrid, Madrid, Spain., Genentech Inc., South San Francisco, CA, USA., Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA.