Background
Renal cell carcinoma (RCC) is a prevalent urinary cancer with an increasing incidence. Immunotherapy, either alone or combined with anti-vascular endothelial growth factor receptor tyrosine kinase inhibitors (TKIs), has become a cornerstone in RCC treatment. However, there's a lack of head-to-head comparisons between treatment strategies, making real-world evidence crucial for guiding clinical decisions.
Objective
The study aimed to assess the outcomes of patients with advanced RCC treated with first-line immune combinations or immune oncology (IO)-TKIs.
Design, Setting, and Participants
Data from 930 patients (654 intermediate risk and 276 poor risk) were collected retrospectively from 58 centers in 20 countries. The study collected special data such as sarcomatoid differentiation, body mass index, prior nephrectomy, metastatic localization, and biochemical data.
Outcome Measurements and Statistical Analysis
Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, with a median follow-up of 18.7 months.
Results and Limitations
Intermediate-risk patients showed significantly longer median OS and PFS with IO + TKI combinations compared to IO + IO (OS: 55.7 vs. 40.2 months; PFS: 30.7 vs. 13.2 months). No significant difference was observed in poor-risk patients between the two treatment strategies. The study acknowledges limitations due to its retrospective nature.
Conclusions
The study highlights the benefits of IO + TKI combinations over IO + IO in intermediate-risk RCC patients, with no significant differences observed in poor-risk patients. These findings could influence daily practice decision-making for RCC treatment.
Patient Summary
This study analyzed the treatment outcomes of 930 advanced RCC patients, finding that intermediate-risk patients benefit more from a combination of immunotherapy and antiangiogenic therapy than from double immunotherapy. No such differences were found in poor-risk patients, potentially impacting treatment decisions.
