Impact of Synchronous versus Metachronous Metastasis on Outcomes in Patients with Metastatic Renal Cell Carcinoma Treated with First-line Immune Checkpoint Inhibitor-based Combinations.

Immune checkpoint inhibitors Metachronous Metastatic renal cell carcinoma Survival outcomes Synchronous

Journal

European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661

Informations de publication

Date de publication:
04 Apr 2024
Historique:
received: 10 01 2024
revised: 04 03 2024
accepted: 22 03 2024
medline: 6 4 2024
pubmed: 6 4 2024
entrez: 5 4 2024
Statut: aheadofprint

Résumé

The impact of time of metastasis onset with respect toprimary renal cell carcinoma (RCC) diagnosis on survival outcomes is not well characterized in the era of immune checkpoint inhibitor (ICI)-based combinations. Herein, we assessed differences in clinical outcomes between synchronous and metachronous metastatic RCC (mRCC). Data for patients with mRCC treated with first-line ICI-based combination therapies between 2014 and 2023 were retrospectively collected. Patients were categorized as having synchronous metastasis if present within 3 mo of RCC diagnosis; metachronous metastasis was defined as metastasis >3 mo after primary diagnosis. Time to treatment failure (TTF), overall survival (OS), and the disease control rate (DCR) were assessed. Our analysis included 223 eligible patients (126 synchronous and 97 metachronous). Median TTF did not significantly differ between the synchronous and metachronous groups (9 vs 19.8 mo; p = 0.063). Median OS was significantly shorter in the synchronous group (28.0 vs 50.9 mo; p = 0.001). Similarly, patients with synchronous metachronous metastasis (58.7% vs. 78.4%; p = 0.002). On multivariable analyses, synchronous metastasis remained independently associated with worse OS and DCR. In this hypothesis-generating study, patients with mRCC with synchronous metastasis who were treated with first-line ICI-based combinations have a poorer OS and worse DCR than those with metachronous mRCC. If these results are externally validated, time to metastasis could be included in prognostic models for mRCC. Our study demonstrates that patients treated with current first-line immunotherapies, who present with metastasis at the initial diagnosis of kidney cancer have worse overall survival compared to those who develop metastasis later. These results can help physicians and patients understand life expectancy.

Sections du résumé

BACKGROUND AND OBJECTIVE OBJECTIVE
The impact of time of metastasis onset with respect toprimary renal cell carcinoma (RCC) diagnosis on survival outcomes is not well characterized in the era of immune checkpoint inhibitor (ICI)-based combinations. Herein, we assessed differences in clinical outcomes between synchronous and metachronous metastatic RCC (mRCC).
METHODS METHODS
Data for patients with mRCC treated with first-line ICI-based combination therapies between 2014 and 2023 were retrospectively collected. Patients were categorized as having synchronous metastasis if present within 3 mo of RCC diagnosis; metachronous metastasis was defined as metastasis >3 mo after primary diagnosis. Time to treatment failure (TTF), overall survival (OS), and the disease control rate (DCR) were assessed.
KEY FINDINGS AND LIMITATIONS UNASSIGNED
Our analysis included 223 eligible patients (126 synchronous and 97 metachronous). Median TTF did not significantly differ between the synchronous and metachronous groups (9 vs 19.8 mo; p = 0.063). Median OS was significantly shorter in the synchronous group (28.0 vs 50.9 mo; p = 0.001). Similarly, patients with synchronous metachronous metastasis (58.7% vs. 78.4%; p = 0.002). On multivariable analyses, synchronous metastasis remained independently associated with worse OS and DCR.
CONCLUSIONS AND CLINICAL IMPLICATIONS CONCLUSIONS
In this hypothesis-generating study, patients with mRCC with synchronous metastasis who were treated with first-line ICI-based combinations have a poorer OS and worse DCR than those with metachronous mRCC. If these results are externally validated, time to metastasis could be included in prognostic models for mRCC.
PATIENT SUMMARY RESULTS
Our study demonstrates that patients treated with current first-line immunotherapies, who present with metastasis at the initial diagnosis of kidney cancer have worse overall survival compared to those who develop metastasis later. These results can help physicians and patients understand life expectancy.

Identifiants

DOI: 10.1016/j.euf.2024.03.006 PMID: 38580524
pubmed: 38580524
pii: S2405-4569(24)00050-6
doi: 10.1016/j.euf.2024.03.006
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier B.V.

Auteurs

Georges Gebrael (G)

Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.

Luis Meza (L)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA.

Xiaochen Li (X)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Zeynep Zengin (Z)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA.

Nicolas Sayegh (N)

Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA.

Hedyeh Ebrahimi (H)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Nishita Tripathi (N)

Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.

Daniela Castro (D)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Benjamin Mercier (B)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Regina Barragan-Carrillo (R)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Haoran Li (H)

Department of Internal Medicine, Division of Medical Oncology, University of Kansas Cancer Center, Westwood, KS, USA.

Alexander Chehrazi-Raffle (A)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Umang Swami (U)

Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.

Abhishek Tripathi (A)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Neeraj Agarwal (N)

Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.

Benjamin L Maughan (BL)

Department of Internal Medicine, Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. Electronic address: benjamin.maughan@hci.utah.edu.

Sumanta K Pal (SK)

Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA. Electronic address: spal@coh.org.

Classifications MeSH