Clinical Effectiveness of Second-line Sunitinib Following Immuno-oncology Therapy in Patients with Metastatic Renal Cell Carcinoma: A Real-world Study.

Limited data exist on the clinical effectiveness of second-line (2L) vascular endothelial growth factor (receptor) targeted inhibitor (VEGF(R)i) sunitinib after first-line (1L) immuno-oncology (IO) therapy for patients with metastatic renal cell carcinoma (mRCC) in real-world settings.

A retrospective cohort study among adult patients with mRCC treated with 2L sunitinib following 1L IO was conducted from select International mRCC Database Consortium (IMDC) centers. All analyses were performed overall and by 1L ipilimumab + nivolumab (IPI+NIVO) or 1L IO+VEGF(R)i. Median overall survival (mOS) and time-to-treatment discontinuation (mTTD) in 2L were estimated using Kaplan-Meier analysis. The 2L objective response rate (ORR) (complete/partial response) was reported.

Among 102 patients on 2L sunitinib, mean age was 61.3 years. IMDC risk scores at 2L initiation was available for 83 patients: 8 (9.6%) were favorable, 45 (54.2%) were intermediate, and 30 (36.1%) were poor risk. The 1L consisted of IPI+NIVO in 62 (60.8%), IO+VEGF(R)i therapy in 27 (26.5%), and IO monotherapy in 13 (12.7%) patients. Among all patients, mOS was 15.6 months (95% confidence interval [CI], 9.8-21.7), with a 1-year OS rate of 57.5% (95% CI, 45.2-68.0). mTTD was 5.4 months (95% CI, 4.2-7.2) and ORR was 22.5%.

Despite availability of effective 1L therapies in recent years, 2L sunitinib continues to have clinical activity after failure of 1L IO. Further studies on optimal treatment sequencing after 1L IO progression are needed.

Clinical genitourinary cancer. 2021 Mar 17 [Epub ahead of print]

J Connor Wells, Shaan Dudani, Chun Loo Gan, Igor Stukalin, Arun A Azad, Elizabeth Liow, Frede Donskov, Takeshi Yuasa, Sumanta K Pal, Guillermo De Velasco, Aaron R Hansen, Benoit Beuselinck, Christian K Kollmannsberger, Thomas Powles, Bradley A McGregor, Mei S Duh, Lynn Huynh, Daniel Y C Heng

Tom Baker Cancer Centre, University of Calgary, Department of Oncology, Calgary, Canada., Peter MacCallum Cancer Centre, Department of Medical Oncology, University of Melbourne, Melbourne, Australia., Walter and Eliza Hall Institute of Medical Research, Division of Systems Biology and Personalized Medicine, Melbourne, Australia., Aarhus University Hospital, Department of Oncology, Aarhus, Denmark., Japanese Foundation for Cancer Research, Department of Urology, Tokyo, Japan., City of Hope Comprehensive Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA, USA., University Hospital 12 de Octubre, Department of Medical Oncology, Madrid, Spain., Princess Margaret Cancer Centre, University of Toronto, Division of Medical Oncology & Hematology, Toronto, Canada., University Hospitals Leuven, Leuven Cancer Institute, Department of Oncology, Leuven, Belgium., British Columbia Cancer Agency, Department of Medicine, Vancouver, Canada., Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Department of Genitourinary Oncology, London, United Kingdom., Dana Farber Cancer Institute, Harvard Medical School, Lank Center for Genitourinary Oncology, Boston, MA, USA., Analysis Group, Inc., Boston, MA, USA., Tom Baker Cancer Centre, University of Calgary, Department of Oncology, Calgary, Canada. Electronic address: .