Nivolumab Plus Ipilimumab, Pembrolizumab Plus Axitinib Garner Similar Safety Results for aRCC

As there is a deficit of head-to-head trials comparing therapies for advanced renal cell carcinoma (aRCC), Dr. Daniel M. Geynisman, of Fox Chase Cancer Center, led a study to determine real-world outcomes of patients with aRCC treated with first-line (1L) nivolumab plus ipilimumab or pembrolizumab plus axitinib. The results were presented at the 2023 International Kidney Cancer Symposium: North America.

The retrospective, physician-abstracted study reviewed the medical charts of 355 patients with aRCC who were treated with 1L nivolumab plus ipilimumab (225 patients) or pembrolizumab plus axitinib (130 patients) between May 2018 and June 2021.

Inverse probability of treatment weighting was performed to provide a balance of baseline characteristics such as age, gender, race, insurance, risk score, Eastern Cooperative Oncology Group performance status, comorbidities, and laboratory values. Researchers assessed several patient outcomes, including overall response rate (ORR), complete response (CR), duration of response (DOR), treatment-free interval (TFI), progression-free survival (PFS), overall survival (OS), and immune-related adverse events (irAEs).

After the cohorts were weighted, each cohort was found to be approximately 60% male, with an average age of 65 years. Ninety percent of patients had intermediate- or poor-risk disease at 1L treatment initiation. The median follow-up for post-1L initiation was 22.4 months in the nivolumab-plus-ipilimumab arm and 19.0 months in the pembrolizumab-plus-axitinib arm.

ORR and median PFS and OS were not significantly different between treatment arms. In the nivolumab-plus-ipilimumab arm, PFS and OS estimates trended longer, DOR and TFI were longer, and more patients experienced CR than those in the pembrolizumab-plus-axitinib arm. The cumulative irAE incidence rate was initially higher in the nivolumab-plus-ipilimumab arm, but rates were similar by the end of the follow-up period.

This real-world analysis shows that after 12 months, the effectiveness and safety of treatment with nivolumab plus ipilimumab and treatment with pembrolizumab plus axitinib remained similar. While some differences were noted, further follow-up is needed.