Immunotherapy-based combinations in the first-line treatment of metastatic renal cell carcinoma with sarcomatoid features: a systematic review and network meta-analysis.

To perform indirect comparisons of efficacy and safety of first-line immune checkpoint inhibitor (ICI)-based combination therapies for renal cell carcinoma with sarcomatoid features (sRCC).

Five trials were included in our network meta-analyses comprising 568 patients. The combinations nivolumab plus ipilimumab and nivolumab plus cabozantinib achieved significant improvement of progression-free survival (PFS), overall survival (OS), and objective response rates (ORR). Nivolumab plus ipilimumab was associated with the highest likelihood of achieving a complete response. All the included combinations significantly improved PFS and ORR. The combinations of pembrolizumab plus axitinib did not show a statistically significant association with OS. Nivolumab plus cabozantinib had the highest likelihood of improving PFS and OS.

Our network meta-analysis demonstrates that sRCC are responsive to immune-based combinations. The dual ICI with nivolumab plus ipilimumab improved all efficacy outcomes and achieved the highest complete response rates (CRR). Although the association of nivolumab plus cabozantinib with CRR was not statistically significant, this combination demonstrated the highest likelihood of PFS and OS improvements.

Current opinion in urology. 2021 Oct 29 [Epub ahead of print]

Fahad Quhal, Keiichiro Mori, Harun Fajkovic, Mesut Remzi, Shahrokh F Shariat, Manuela Schmidinger

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia Department of Urology, Jikei University School of Medicine, Tokyo, Japan Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic Department of Urology, Weill Cornell Medical College, New York, NY, USA Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

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