The incidence of renal cell carcinoma (RCC) increases with age, yet older patients (≥70 years) are underrepresented in clinical trials. Evidence on the efficacy of immune checkpoint inhibitors (ICIs) and on reliable prognostic tools for this population remains limited.
We aimed to evaluate the effectiveness of nivolumab-based immunotherapy in older patients with metastatic RCC (mRCC) and assess the prognostic accuracy of the International Metastatic RCC Database Consortium (IMDC) and Meet-URO scores.
This multicenter study included 889 patients with mRCC treated with nivolumab alone or in combination with ipilimumab, using data from the Meet-URO 15 study and the Italian Expanded Access Program. Progression-free survival (PFS), overall survival (OS), and prognostic factors were analyzed by age group (<70 and ≥ 70 years) using Kaplan-Meier curves and multivariate models.
Median OS and PFS were similar between younger and older patients (mOS: 23.5 vs. 25.1 months, HR: 1.02, p = 0.82; mPFS: 6.28 vs. 7.82 months, HR: 0.93, p = 0.40). The Meet-URO score outperformed the IMDC score in prognostic accuracy (p < 0.001), particularly in older patients. Non-clear cell histology was linked to shorter PFS (HR: 1.37, p = 0.05), while prior nephrectomy improved OS (HR: 0.55, p = 0.001). Limitations include the retrospective design and treatment heterogeneity. Prospective validation is needed.
In this large real-world cohort, outcomes in older patients with mRCC receiving nivolumab-based immunotherapy were comparable to those in younger patients. The Meet-URO score improved prognostic stratification and supported clinical decision-making.
Journal of geriatric oncology. 2025 Aug 12 [Epub ahead of print]
Veronica Murianni, Marina Campione, Malvina Cremante, Umberto Basso, Lucia Fratino, Sebastiano Buti, Sergio Bracarda, Marco Maruzzo, Ugo De Giorgi, Giampaolo Tortora, Silvia Chiellino, Lorenzo Antonuzzo, Luca Galli, Paolo Andrea Zucali, Mimma Rizzo, Alessio Signori, Diana Giannarelli, Giuseppe Procopio, Pasquale Rescigno, Giuseppe Fornarini, Sara Elena Rebuzzi, Giuseppe Luigi Banna
Medical Oncology, Azienda Sanitaria Locale 1 Imperiese, Ospedale Sanremo, Italy. Electronic address: ., Faculty of Economics and Law of University of Enna Kore, 94100 Enna, Italy., Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy., Oncology 3 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy., Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy., Medical Oncology Unit, University Hospital of Parma, Parma 43126, Italy; Department of Medicine & Surgery, University of Parma, Parma 43121, Italy., Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy., Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy., Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Translational Medicine, Catholic University of the Sacred Heart, Rome, Italy., Department of Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy., Medical Oncology Unit, Careggi University Hospital, Florence 50134, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy., Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Oncology, IRCCS, Humanitas Clinical & Research Center, Rozzano, Milano, Italy., Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy., Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy., Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Candiolo Cancer Institute, FPO-IRCCS, Candiolo 10060, Italy., Medical Oncology Unit, Ospedale San Paolo, Savona 17100, Italy., Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, United Kingdom; Faculty of Science & Health, School of Pharmacy & Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2UP, United Kingdom.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40803027