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Different outcomes among patients with intermediate-risk metastastic renal cell carcinoma treated with first-line tyrosine-kinase inhibitors

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Abstract

Introduction

Systemic therapy of patients with metastatic renal cell carcinoma (mRCC) has improved in the past years, with the advent of new immunotherapy-based combinations as a standard treatment option for first-line therapy. Nevertheless, particularly in good-risk patients by IMDC criteria, tyrosine-kinase inhibitors (TKI) may remain as an option for some patients. We reviewed our experience with TKI as first-line therapy for mRCC patients, trying to identify subgroups of patients that may still benefit from this strategy.

Material and methods

All patients with mRCC treated with first-line TKI, and adequate follow-up, in University Hospital La Paz (Madrid, Spain) between 2007 and 2020 were analyzed. Patients treated inside a clinical trial were excluded from this analysis.

Results

A total of 90 patients treated with first-line TKI were included. Regarding IMDC criteria, 33 patients (36.7%) were good-risk, 41 patients (45.5%) intermediate-risk, and 16 patients (17.8%) poor-risk. With a median follow-up of 49 months, the median overall survival (OS) for good, intermediate, and poor-risk patients was 54, 24, and 16 months (p = 0.004). When intermediate-risk was divided into patients with 1 or 2 risk factors, differences in OS were also statistically significant: patients with 1 risk factor had a median OS of 33 months, while patients with 2 risk factors had a median OS of 16 months, the same as poor-risk patients (p = 0.003). In the multivariate analysis, trying to find out which of the IMDC factors had a more remarkable weight in the prognosis of the patients, both ECOG and hemoglobin levels by themselves were significantly associated with OS.

Conclusion

In our group of patients, survival outcomes were different among patients with intermediate-risk with 1 or 2 risk factors by IMDC criteria. These could help select patients that may benefit from first-line treatment with a TKI, particularly in settings with difficult access to novel therapies, such as immunotherapy-based combinations.

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Data availability

Data available upon request.

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Authors and Affiliations

  1. Medical Oncology Department, University Hospital La Paz–IdiPAZ, Paseo Castellana 261, 28046, Madrid, Spain

    Álvaro Pinto, Ana Pertejo & Enrique Espinosa

  2. Medical Oncology Department, QuironSalud University Hospital, Madrid, Spain

    Jesús Miranda

  3. Urology Department, University Hospital La Paz–IdiPAZ, Madrid, Spain

    Mario Álvarez-Maestro & Alfredo Aguilera

  4. Pathology Department, University Hospital La Paz–IdiPAZ, Madrid, Spain

    Pilar González-Peramato & Eugenia García

  5. Molecular Oncology and Pathology Lab, University Hospital La Paz–IdiPAZ, Madrid, Spain

    Lucía Trilla & Ángelo Gámez

Authors
  1. Álvaro Pinto
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  2. Jesús Miranda
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  3. Ana Pertejo
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  4. Mario Álvarez-Maestro
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  5. Pilar González-Peramato
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  6. Alfredo Aguilera
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  7. Eugenia García
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  8. Lucía Trilla
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  9. Ángelo Gámez
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  10. Enrique Espinosa
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Contributions

JM, ÁP: conceptualization, data curation, methodology, investigation, writing—original draft, writing—review and editing. AP: conceptualization, data curation, methodology, investigation, writing—original draft. MÁ-M, PG-P, AA, EG, LT, ÁG, EE: data curation, methodology, investigation.

Corresponding author

Correspondence to Álvaro Pinto.

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Conflict of interest

Álvaro Pinto: Speaker fees—advisory board: Janssen, Astellas, Pfizer, GSK, Novartis, Ipsen, Bristol-Myers-Squibb, MSD, Eisai, Bayer. Research grants: Pfizer, Bristol-Myers-Squibb. Ana Pertejo: Speaker fees—advisory board: Janssen, Astellas. The rest of the authors do not have relevant conflicts of interest to disclose.

Ethical approval (Research involving human participants and/or animals)

The study was approved by the Ethics Committee of Hospital Universitario La Paz, project PI-3310. This was a retrospective, non-interventional study, so there was no formal sample processing or research involving humans.

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Informed consent was obtained from all patients.

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Pinto, Á., Miranda, J., Pertejo, A. et al. Different outcomes among patients with intermediate-risk metastastic renal cell carcinoma treated with first-line tyrosine-kinase inhibitors. Clin Transl Oncol 26, 532–537 (2024). https://doi.org/10.1007/s12094-023-03274-7

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  • DOI: https://doi.org/10.1007/s12094-023-03274-7

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