Non-IO, Non-TKI Treatments Needed for Patients With mRCC, Prior IO-TKI Therapy

As the treatment landscape for metastatic renal cell carcinoma (mRCC) is rapidly growing, Dr. Neil Shah and fellow researchers from the Memorial Sloan Kettering Cancer Center sought to determine the real-world treatment patterns and outcomes of subsequent lines of treatment (LOT) in patients with mRCC who received prior immunotherapy (IO) and tyrosine kinase inhibitor (TKI) therapy.

A group of 239 patients with mRCC who had received a subsequent LOT after receiving IO and TKI therapy, combined or in sequence, between January 2018 and September 2020 were followed until April 2022. Patient data were gathered from The US Oncology Network electronic health record database, iKnowMed.

Overall survival (OS) and real-world progression-free survival (rwPFS) from index date were described using Kaplan-Meier analysis. The median age of the patient group was 67 years (range, 58 to 73 years); 73.6% were male, 63.6% had an Eastern Cooperative Oncology Group performance status of 0 to 1, and 61.5% had an intermediate or poor International mRCC Database Consortium risk score.

Out of the total patient group, subsequent therapy was administered to 29 patients (12.1%) at LOT2, 167 (69.8%) at LOT3, and 43 (18.0%) at LOT4. TKI monotherapy and TKI plus non-IO therapy was the most common (71.5%) subsequent treatment utilized in patients after receiving IO and TKI, including cabozantinib (38.5%) and axitinib (10.5%).

The median OS for LOT2, LOT3, and LOT4 was 18.0, 17.0, and 26.9 months, respectively (P=.84). No meaningful difference in OS was noted across treatment classes (P=.40), and there was no meaningful difference in rwPFS across LOTs (P=.88) or treatment classes (P=.19).

The majority of patients with mRCC who were treated with IO and TKI, in combination or sequence, received a subsequent therapy at LOT3, with a preference toward TKI-based treatments. No meaningful difference was seen in OS or rwPFS in patients treated subsequently with IO monotherapy, IO plus IO, TKI monotherapy/TKI plus non-IO therapy, or mTOR.

This patient population is in need of treatments with newer modes of action (non-IO/non-TKI).