Nivolumab plus cabozantinib (N+C) versus sunitinib (S) for advanced renal cell carcinoma (aRCC): Outcomes by baseline disease characteristics in the phase 3 CheckMate 9ER trial.

Authors

Andrea Apolo

Andrea B. Apolo

National Cancer Institute, National Institutes of Health, Bethesda, MD

Andrea B. Apolo , Thomas Powles , Mauricio Burotto , Maria Teresa Bourlon , James J Hsieh , Umberto Basso , Amishi Yogesh Shah , Cristina Suarez , Camillo Porta , Carlos H. Barrios , Howard Gurney , Elizabeth R Kessler , Margitta Retz , Saby George , Bernard Escudier , Joshua Zhang , Burcin Simsek , Christian Scheffold , Robert J. Motzer , Toni K. Choueiri

Organizations

National Cancer Institute, National Institutes of Health, Bethesda, MD, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free National Health Service Trust, London, United Kingdom, Bradford Hill Clinical Research Center, Santiago, Chile, Urologic Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, DF, Mexico, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy, MD Anderson Cancer Center, Houston, TX, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus, Barcelona, Spain, University of Pavia, Pavia, Italy, Hospital São Lucas, PUCRS, Porto Alegre, Brazil, Westmead Hospital and Macquarie University, Sydney, NSW, Australia, University of Colorado School of Medicine, Aurora, CO, Rechts der Isar Medical Center, Technical University Munich, Munich, Germany, Roswell Park Comprehensive Cancer Center, Buffalo, NY, Gustave Roussy, Villejuif, France, Bristol Myers Squibb, Princeton, NJ, Exelixis, Inc., Alameda, CA, Memorial Sloan Kettering Cancer Center, New York, NY, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA

Research Funding

Pharmaceutical/Biotech Company
Bristol Myers Squibb

Background: First-line N+C significantly improved progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) vs S in aRCC patients (pts) in the phase 3 CheckMate 9ER trial, leading to FDA approval of N+C in this setting. A deeper understanding of how baseline disease characteristics may impact clinical outcomes with N+C vs S may inform clinical decision making. Methods: Pts with clear cell aRCC were randomized to N 240 mg IV Q2W + C 40 mg PO QD vs S 50 mg PO QD (4 weeks of 6-week cycles). In this post hoc exploratory analysis, PFS, OS, and ORR were evaluated across pt subgroups defined by baseline IMDC risk status, organ sites of metastases (mets), number of organs with any lesions, or target lesion size. Consistent with primary/secondary efficacy endpoints in ITT pts, PFS and ORR were evaluated per RECIST v1.1 by blinded independent central review in subgroups. Results: Median follow-up in ITT pts was 23.5 months. PFS, OS, and ORR (including complete response [CR]) outcomes are summarized in the table across subgroups: IMDC risk (favorable [FAV], intermediate [I], poor [P]); number of organs with ≥ 1 target/nontarget lesion (T/NT; 1 and ≥ 2); sum of diameters of target lesions (sDTL; < and ≥ median [72.1 mm]), and in pts with liver, bone, or lung mets. The PFS HR favored N+C vs S and median (m) PFS was longer with N+C vs S across all subgroups. The OS HR also favored N+C vs S across most subgroups. ORR ranged from 38%–66% (N+C) vs 10%–44% (S) across subgroups, and CR benefits were seen with N+C in most subgroups. Additional outcomes including landmark OS and response details in subgroups will be reported. Conclusions: Consistent with outcomes in ITT pts, efficacy benefits with N+C vs S were observed regardless of IMDC risk status, organ site of mets, or extent of tumor burden at baseline. These results support N+C as a new first-line treatment option for pts with aRCC. Clinical trial information: NCT03141177

Subgroup

(N+C v S, n)
FAV risk

(74 v 72)
I risk

(188 v 188)
P risk

(61 v 68)
1 organ

site

with T/NT

(61 v 68)
≥ 2 organ sites

with T/NT

(261 v 258)
sDTL

< 72.1 mm

(160 v 167)
sDTL

≥ 72.1 mm

(163 v 161)
Pts w/ lung

mets

(240 v 251)
Pts w/ bone

mets

(79 v 72)
Pts w/ liver

mets

(73 v 54)
PFS, HR (95%)
0.58

(0.36–0.93)
0.58

(0.45–0.76)
0.36

(0.23–0.56)
0.53

(0.32–0.88)
0.53

(0.43–0.67)
0.52

(0.39–0.71)
0.53

(0.40–0.70)
0.51

(0.40–0.64)
0.38

(0.25–0.59)
0.51

(0.33–0.79)
mPFS, mo
25 v 13
17 v 9
10 v 4
25 v 13
15 v 7
20 v 10
11 v 6
17 v 8
18 v 4
11 v 6
OS, HR (95%)
0.94

(0.46–1.92)
0.74

(0.50–1.08)
0.45

(0.27–0.76)
0.79

(0.33–1.90)
0.63

(0.47–0.84)
0.64

(0.38–1.06)
0.64

(0.46–0.89)
0.63

(0.46–0.86)
0.64

(0.39–1.06)
0.47

(0.27–0.82)
ORR per RECIST v1.1 (95% CI), %
66 (54–77)

v

44 (33–57)
56 (48–63)

v

29 (22–36)
38 (26–51)

v

10 (4–20)
62 (49–74)

v

35 (24–48)
53 (47–59)

v

27 (21–33)
62 (54–69)

v

36 (29–44)
48 (40–56)

v

20 (15–28)
56 (49–62)

v

29 (24–36)
48 (37–60)

v

11 (5–21)
49 (37–61)

v

20 (11–34)
CR, %
9 v 10
11 v 3
5 v 1
20 v 4
7 v 4
16 v 8
2 v 0
8 v 4
6 v 0
1 v 2

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Genitourinary Cancer—Kidney and Bladder

Track

Genitourinary Cancer—Kidney and Bladder

Sub Track

Kidney Cancer

Clinical Trial Registration Number

NCT03141177

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 4553)

DOI

10.1200/JCO.2021.39.15_suppl.4553

Abstract #

4553

Poster Bd #

Online Only

Abstract Disclosures