Memorial Sloan Kettering Cancer Center, New York, NY
Neil J. Shah , Sneha Sura , Reshma Shinde , Junxin Shi , Rodolfo F. Perini , Singhal Puneet , Nicholas J. Robert , Nicholas J. Vogelzang , Robert J. Motzer
Background: IO agents and TKIs have revolutionized treatment landscape of mRCC pts. Despite robust clinical trials’ data for these agents, real-world (rw) clinical outcomes data, especially from community setting in the US is limited. Methods: This retrospective cohort study included mRCC pts who received 1L treatment with either, pembrolizumab + axitinib (P+A) (IO+TKI), ipilimumab + nivolumab (I+P) (IO+IO) or cabozantinib, sunitinib, pazopanib and axitinib (TKI monotherapy (mono)) between 1/1/2018 and 9/30/2020 from The US Oncology Network of 480 sites. Patients were followed until 12/31/2020 to collect data on rw-time on treatment (rwToT), rw-time to next treatment (rwTTNT) and overall survival (OS). Kaplan-Meier analyses were performed to examine clinical outcomes. Results: We identified 1,538 eligible pts, of which 18% (n = 279) received P+A, 42% (n = 641) I+N and 40% (n = 618) TKI mono. The median follow-up duration for P+A, I+N and TKI mono cohort was 7.2 (range 0.0 - 20.5), 8.5 (range 0.0 - 32.3) and 7.8 (range 0.0 - 35.3) months, respectively. Majority of pts had clear cell histology (P+A - 82%, I+N - 86%, and TKI mono - 72%) and intermediate/poor IMDC risk score (P+A - 87%, I+N - 94%, and TKI mono - 81%). Median OS was not reached for P+A and was similar for I+N and TKI mono cohort (NR, 27.6, and 26.9 months, p=0.237, respectively). The median rwToT (13.6 vs. 5.8 vs. 3.4 months, p<0.0001) and rwTTNT (16.4 vs. 8.3 vs. 8.4 months, p<0.0001) was higher for P+A cohort compared to I+N and TKI mono cohort, respectively. Similar clinical outcomes results were noted for subgroup of pts with intermediate and/or poor IMDC risk score (Table). Conclusions: In this rw US community oncology-based study, longer treatment exposure (rwToT, rwTTNT) was noted in P+A compared to I+N or TKI mono. These rw endpoints may reflect treatment exposure, tolerability and/or compliance.
Clinical outcomes (months) 95% CI | P+A (n=279) | I+N (n=641) | TKI mono (n=618) | Log-Rank p-value | P+A (Intermediate/Poor) (n=239) | I+N (Intermediate/Poor) (n=599) | TKI mono (Intermediate/Poor) (n=499) | Log-Rank p-value |
---|---|---|---|---|---|---|---|---|
Median rwToT | 13.6 (10.4, NR*) | 5.8 (5.3,7.3) | 3.4 (2.8,4.3) | <0.0001 | 13.6 (9.6, NR) | 5.7 (5.1,7.3) | 2.8 (2.0,3.5) | <0.0001 |
12-month probability | 51.3% (43.2,58.8) | 34.8% (30.5,39.1) | 23.4% (19.4,27.7) | 50.3% (41.5,58.4) | 34.6% (30.1,39.0) | 19.2% (15.0,23.8) | ||
Median rwTTNT | 16.4 (11.9, NR) | 8.3 (7.3,10.2) | 8.4(6.9,9.6) | <0.0001 | 14.6 (11.4, NR) | 8.2 (7.2,10.0) | 7.2 (6.0,8.4) | <0.0001 |
12-month probability | 57.6% (49.6,64.8) | 42.1% (37.6,46.4) | 38.2% (33.6,42.8) | 54.9% (46.0,62.9) | 41.4% (36.8,45.9) | 33.1% (28.1,38.2) | ||
Median OS | NR (NR, NR) | 27.6 (21.7,30.9) | 26.9 (21.6, NR) | 0.2367 | NR (NR, NR) | 26.2 (21.3,30.9) | 21.6 (17.5,26.9) | 0.0468 |
12-month probability | 76.4% (69.7,81.8) | 72.6% (68.4,76.3) | 70.0% (65.6,74.0) | 75.8% (68.2,81.8) | 71.0% (66.6,75.0) | 66.9% (61.8,71.5) |
*NR: Not Reached
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