AI Article Synopsis

  • Nivolumab plus ipilimumab (NIVO+IPI) is the primary treatment for metastatic renal cell carcinoma (mRCC), with about 40% of patients achieving a lasting response, but 20% show primary resistance to the treatment.
  • This study analyzed data from 120 mRCC patients treated with NIVO+IPI from August 2015 to January 2023, focusing on factors linked to primary resistant disease (PRD) and patient outcomes.
  • The findings revealed that PRD was associated with significantly worse overall survival, and lymph node metastasis (LNM) was identified as an independent risk factor for developing PRD, suggesting some patients may not benefit from NIVO+IPI therapy.

Article Abstract

Background: Nivolumab plus ipilimumab (NIVO+IPI) is the first-line treatment for patients with metastatic renal cell carcinoma (mRCC). Approximately 40% of patients achieve a durable response; however, 20% develop primary resistant disease (PRD) to NIVO+IPI, about which little is known in patients with mRCC. Therefore, this investigation aimed to evaluate the clinical implication of PRD in patients with mRCC to select better candidates in whom NIVO+IPI can be initiated as first-line therapy.

Methods: This multi-institutional retrospective cohort study used data collected between August 2015 and January 2023. In total, 120 patients with mRCC treated with NIVO+IPI were eligible. Associations between immune-related adverse events and progression-free survival, overall survival (OS), and objective response rate were analyzed. The relationship between other clinical factors and outcomes was also evaluated.

Results: The median observation period was 16 months (interquartile range, 5-27). The median age at NIVO+IPI initiation was 68 years in the male-dominant population (n = 86, 71.7%), and most patients had clear cell histology (n = 104, 86.7%). PRD was recorded in 26 (23.4%) of 111 investigated patients during NIVO+IPI therapy. Patients who experienced PRD showed worse OS (hazard ratio: 4.525, 95% confidence interval [CI]: 2.315-8.850, p < 0.001). Multivariable analysis showed that lymph node metastasis (LNM) (odds ratio: 4.274, 95% CI: 1.075-16.949, p = 0.039) was an independent risk factor for PRD.

Conclusions: PRD was strongly correlated with worse survival rates. LNM was independently associated with PRD in patients with mRCC receiving NIVO+IPI as first-line therapy and might indicate that a candidate will not benefit from NIVO+IPI.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10501267PMC
http://dx.doi.org/10.1002/cam4.6306DOI Listing

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