Treatment-free survival after discontinuation of immune checkpoint inhibitors in metastatic renal cell carcinoma: a systematic review and meta-analysis
Autor: | Tony H. Tzeng, Alice Tzeng, Moshe Chaim Ornstein |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty medicine.medical_treatment Immunology Review Cochrane Library urologic neoplasms Renal cell carcinoma Internal medicine medicine Immunology and Allergy Humans Prospective cohort study Carcinoma Renal Cell Immune Checkpoint Inhibitors RC254-282 Aged Pharmacology clinical trials as topic business.industry Neoplasms. Tumors. Oncology. Including cancer and carcinogens Immunotherapy Middle Aged medicine.disease Survival Analysis Kidney Neoplasms Discontinuation Clinical trial Regimen Meta-analysis Molecular Medicine Female immunotherapy business hormones hormone substitutes and hormone antagonists |
Zdroj: | Journal for ImmunoTherapy of Cancer, Vol 9, Iss 10 (2021) Journal for Immunotherapy of Cancer |
ISSN: | 2051-1426 |
Popis: | While immune checkpoint inhibitors (ICI) can lead to sustained responses in metastatic renal cell carcinoma (mRCC), the optimal duration of therapy remains unknown. We aimed to examine treatment-free survival (TFS) in objective responders who discontinued ICI and to explore factors that may impact objective response rate (ORR) and TFS. MEDLINE/PubMed, Embase, and the Cochrane Library were searched for prospective studies reporting individual outcomes after ICI discontinuation in patients with mRCC. Pooled ORR and TFS were estimated using random-effects meta-analyses, and associations between ICI regimen type or treatment line and ORR or TFS were evaluated. Sixteen cohorts comprising 1833 patients treated with ICI were included. The pooled ORR was 43% (95% CI 33% to 53%), and significant differences in summary estimates existed among patients who received ICI monotherapy (22%, 95% CI 18% to 26%), ICI plus a vascular endothelial growth factor (VEGF) pathway inhibitor (57%, 95% CI 48% to 65%), and dual ICI (40%, 95% CI 36% to 44%). Of 572 responders who had available data, 327 stopped ICI, with 86 (26%) continuing to respond off-treatment. Pooled TFS rates at 6 and 12 months were 35% (95% CI 20% to 50%) and 20% (95% CI 8% to 35%), respectively, and were highest for responders treated with dual ICI and lowest for those treated with ICI plus a VEGF pathway inhibitor. Thus, a subset of patients with mRCC who are treated with ICI-based therapy can have durable TFS after therapy discontinuation. Prospective clinical trials and biomarkers are needed to identify patients who can discontinue ICI therapy without compromising clinical outcomes. |
Databáze: | OpenAIRE |
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