A Systematic Review and Meta-analysis of Dual Therapy in Patients With Advanced Renal Cell Carcinoma of Favourable Risk - 09/12/21

Abstract |
Objective |
To define the impact of first-line dual therapy involving immune checkpoint inhibitors (ICI) on survival outcomes in patients with advanced renal cell carcinoma (aRCC) of International Metastatic RCC Database Consortium favourable-risk.
Materials and Methods |
Systematic review of Medline, EMBASE, and Cochrane Central Register of Controlled trials were conducted to select all phase II/III randomized clinical trials involving first-line, palliative-intent dual therapy in aRCC patients of favourable-risk. Inverse-variance with random-effects model was used for meta-analysis. Sensitivity analysis with exclusion of immune checkpoint inhibitors (ICI)-ICI combination was conducted. Study outcomes were overall survival (OS) and progression free survival (PFS).
Results |
Seven phase II/III randomized controlled trials (N = 1214) were included in the meta-analysis. There were no significant OS differences detected in the favourable-risk group on dual therapy in comparison to sunitinib monotherapy (HR 0.96, 95%CI 0.73-1.26, P = .79). Sensitivity analysis also did not show significant OS benefit when excluding ICI-ICI regimen (HR 0.99, 95%CI 0.69-1.43, P = .96). PFS was not shown to have significant benefit for dual therapy in the favourable-risk group (HR 0.75, 95%CI 0.50-1.13, P = .17), but it met statistical significance when ICI-ICI regimen was excluded from the analysis (HR 0.63, 95%CI 0.50-0.79, P <.001).
Conclusion |
There was no OS benefit when comparing dual therapy vs sunitinib monotherapy in aRCC favourable-risk group. Longer follow-up would be required to definitively detect potential OS benefit, if any. Careful patient-clinician discussion of alternative management options are required prior to initiating dual-therapy in all aRCC favourable-risk group.
Le texte complet de cet article est disponible en PDF.KEYWORDS : Metastatic renal cell carcinoma, IMDC favourable risk, systemic therapy, immune checkpoint inhibitor, meta analysis
Plan
Conflict of Interest: Dr. Kartolo, Dr. Holstead, and Dr. Vera Badillo do not have conflict of interest to declare. Dr. Robinson has received honoraria from Merck, BMS, AstraZeneca, and Roche. Dr. Ignacio Duran has received honoraria from BMS, MSD, PFIZER, NOVARTIS, IPSEN, and EUSA PHARMA. He has served as a consultant/advisor for BMS, MSD, PFIZER, NOVARTIS, IPSEN, and Pharmacyclics. |
Vol 157
P. 8-14 - novembre 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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