Ipi/Nivo Provides Better OS & FS in Older Adult Populations With mRCC

While older patients and those with poor performance status make up a large portion of patients seen in the clinical setting, these patients are often excluded from clinical trials. Because of this, there is limited data available to guide treatment decision-making for these patient groups.

A recent study has analyzed the real-world patient data of older adults and less fit patients with metastatic renal cell carcinoma (mRCC) to determine how the clinical outcomes of treatment with nivolumab plus ipilimumab in these patient populations compare to those of younger patients.

Results from the CheckMate 214 trial demonstrated the positive impact of ipilimumab plus nivolumab in patients with mRCC and intermediate or poor-risk disease based on the International Metastatic RCC Database Consortium (IMDC) through its improvement in overall survival (OS) over sunitinib.

This recent real-world cohort study involved 551 patients with mRCC treated with first-line ipilimumab plus nivolumab whose data was analyzed from the Canadian Kidney Cancer information system from January 2014 to December 2021.

To compare outcomes and toxicity, patients were separated into 3 groups: <70 versus ≥70 years old, <75 versus ≥75 years old, and KPS in patients ≥70 versus <70 years old. OS, progression-free survival (PFS), and time to treatment failure were calculated using Kaplan-Meier analysis. Groups were compared using log-rank tests.

No impact on survival outcomes or toxicity through treatment with ipilimumab plus nivolumab was seen in patients >70 and >75 years old when controlled for IMDC criteria. When comparing patients with KPS >70 versus KPS <70, patients with poor performance status had a decreased median OS of 54.5 months versus 10.8 months (P<0.0001), and a PFS time of 11.6 versus 3.1 months (P<0.0001).

The combination therapy of ipilimumab with nivolumab for an older adult patient population with mRCC provided similar survival rates and toxicity. However, in patients with poor performance status, the combination was linked to inferior OS and PFS rates. Ipilimumab plus nivolumab may be a promising treatment option for mRCC, especially in older patients.