TY - JOUR
T1 - Prognostic outcomes in patients with metastatic renal cell carcinoma receiving second-line treatment with tyrosine kinase inhibitor following first-line immune-oncology combination therapy
AU - Matsushita, Yuto
AU - Kojima, Takahiro
AU - Osawa, Takahiro
AU - Sazuka, Tomokazu
AU - Hatakeyama, Shingo
AU - Goto, Keisuke
AU - Numakura, Kazuyuki
AU - Yamana, Kazutoshi
AU - Kandori, Shuya
AU - Fujita, Kazutoshi
AU - Ueda, Kosuke
AU - Tanaka, Hajime
AU - Tomida, Ryotaro
AU - Kurahashi, Toshifumi
AU - Bando, Yukari
AU - Nishiyama, Naotaka
AU - Kimura, Takahiro
AU - Yamashita, Shimpei
AU - Kitamura, Hiroshi
AU - Miyake, Hideaki
N1 - Publisher Copyright:
© 2024 The Japanese Urological Association.
PY - 2024/5
Y1 - 2024/5
N2 - Objectives: This study aimed to assess the prognostic outcomes in mRCC patients receiving second-line TKI following first-line IO combination therapy. Methods: This study retrospectively included 243 mRCC patients receiving second-line TKI after first-line IO combination therapy: nivolumab plus ipilimumab (n = 189, IO–IO group) and either pembrolizumab plus axitinib or avelumab plus axitinib (n = 54, IO–TKI group). Oncological outcomes between the two groups were compared, and prognostication systems were developed for these patients. Results: In the IO–IO and IO–TKI groups, the objective response rates to second-line TKI were 34.4% and 25.9% (p = 0.26), the median PFS periods were 9.7 and 7.1 months (p = 0.79), and the median OS periods after the introduction of second-line TKI were 23.1 and 33.5 months (p = 0.93), respectively. Among the several factors examined, non-CCRCC, high CRP, and low albumin levels were identified as independent predictors of both poor PFS and OS by multivariate analyses. It was possible to precisely classify the patients into 3 risk groups regarding both PFS and OS according to the positive numbers of the independent prognostic factors. Furthermore, the c-indices of this study were superior to those of previous systems as follows: 0.75, 0.64, and 0.61 for PFS prediction and 0.76, 0.70, and 0.65 for OS prediction by the present, IMDC, and MSKCC systems, respectively. Conclusions: There were no significant differences in the prognostic outcomes after introducing second-line TKI between the IO–IO and IO–TKI groups, and the histopathology, CRP and albumin levels had independent impacts on the prognosis in mRCC patients receiving second-line TKI, irrespective of first-line IO combination therapies.
AB - Objectives: This study aimed to assess the prognostic outcomes in mRCC patients receiving second-line TKI following first-line IO combination therapy. Methods: This study retrospectively included 243 mRCC patients receiving second-line TKI after first-line IO combination therapy: nivolumab plus ipilimumab (n = 189, IO–IO group) and either pembrolizumab plus axitinib or avelumab plus axitinib (n = 54, IO–TKI group). Oncological outcomes between the two groups were compared, and prognostication systems were developed for these patients. Results: In the IO–IO and IO–TKI groups, the objective response rates to second-line TKI were 34.4% and 25.9% (p = 0.26), the median PFS periods were 9.7 and 7.1 months (p = 0.79), and the median OS periods after the introduction of second-line TKI were 23.1 and 33.5 months (p = 0.93), respectively. Among the several factors examined, non-CCRCC, high CRP, and low albumin levels were identified as independent predictors of both poor PFS and OS by multivariate analyses. It was possible to precisely classify the patients into 3 risk groups regarding both PFS and OS according to the positive numbers of the independent prognostic factors. Furthermore, the c-indices of this study were superior to those of previous systems as follows: 0.75, 0.64, and 0.61 for PFS prediction and 0.76, 0.70, and 0.65 for OS prediction by the present, IMDC, and MSKCC systems, respectively. Conclusions: There were no significant differences in the prognostic outcomes after introducing second-line TKI between the IO–IO and IO–TKI groups, and the histopathology, CRP and albumin levels had independent impacts on the prognosis in mRCC patients receiving second-line TKI, irrespective of first-line IO combination therapies.
KW - OS
KW - PFS
KW - first-line IO combination therapy
KW - risk classification
KW - second-line TKI
UR - http://www.scopus.com/inward/record.url?scp=85182677248&partnerID=8YFLogxK
U2 - 10.1111/iju.15396
DO - 10.1111/iju.15396
M3 - 学術論文
C2 - 38240169
AN - SCOPUS:85182677248
SN - 0919-8172
VL - 31
SP - 526
EP - 533
JO - International Journal of Urology
JF - International Journal of Urology
IS - 5
ER -