Predicting ICB Response in Patients With RCC

A study presented at the 2023 International Kidney Cancer Symposium: North America provided data suggesting that radiographic and radiomic features may predict pathologic response in patients with metastatic renal cell carcinoma (mRCC) with primary kidney tumor.

The researchers, led by Dr. Stephen Reese, of Memorial Sloan Kettering Cancer Center, noted that in patients with mRCC, immune checkpoint blockade (ICB) alone and in combination with other treatments has demonstrated efficacy in improving outcomes, while the lack of biomarkers predicting ICB response has inhibited patient care.

Dr. Reese and colleagues collected the data of 185 patients with RCC who received systemic immune checkpoint blockade (immunotherapy/immunotherapy [IO/IO] or immunotherapy/tyrosine kinase inhibitor [IO/TKI]) from 2015 to 2022. Sixty-two of the patients presented with primary kidney tumor.

The researchers evaluated the radiographic information of patients with the primary tumor present. They collected data from the time of first treatment to treatment failure, reception of second-line therapy or surgical intervention, radiographic kinetics showing response to therapy, Response Evaluation Criteria in Solid Tumors measurements, and 145 radiomic features.

The data showed a 1:1 response in change in primary versus metastatic tumor volume during the duration of the study. Researchers noted outliers who demonstrated changes in metastatic sites of disease. Patients who received IO/IO showed no difference in maximal tumor shrinkage when compared with patients who received IO/TKI (P=.41). Clinical outcomes and kinetics of radiographic change were not associated.

A difference in primary tumor size from the diagnostic scan to the scan preceding surgery (P=.002) and the contrast enhancement of the primary tumor prior to surgery (P=.02) demonstrated connections with residual viable tumor.

Dr. Reese and colleagues observed 4 first- and second-order radiomic features identifying patients with measurable residual disease when analyzing the radiographic features of a patient’s response to systemic therapy.

“This information is important in helping quantify clinical response in patients receiving systemic therapy and may be important in guiding treatment decisions and delineating prognosis,” they wrote.