A Multi-institutional, Retrospective Analysis of Patients with Metastatic Renal Cell Carcinoma to Bone Treated with Combination Ipilimumab and Nivolumab
Autor: | Moshe Chaim Ornstein, Kathryn E. Beckermann, Kunal Desai, Chester Kao, Emily N. Kinsey, Tian Zhang, Landon C. Brown, Brian I. Rini, Wei Wei, Matthew D. Tucker |
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Rok vydání: | 2021 |
Předmět: |
Male
Cancer Research medicine.medical_specialty medicine.medical_treatment Ipilimumab Gastroenterology Article Renal cell carcinoma Internal medicine Humans Medicine Pharmacology (medical) Carcinoma Renal Cell Retrospective Studies business.industry Proportional hazards model Medical record Hazard ratio Immunotherapy medicine.disease Kidney Neoplasms Nivolumab Oncology Female business Progressive disease medicine.drug |
Zdroj: | Target Oncol |
ISSN: | 1776-260X 1776-2596 |
Popis: | BACKGROUND: Bone metastases (BM) in renal cell carcinoma (RCC) patients are associated with poor outcomes. There are limited published data on outcomes in these patients with immunotherapy agents. We present a multi-institutional, retrospective analysis of metastatic RCC patients with BM treated with ipilimumab and nivolumab (I + N). OBJECTIVE: Patient, tumor, and treatment-related variables were retrospectively collected from electronic medical records of patients with a histologically confirmed diagnosis of RCC and at least one radiographically confirmed BM prior to initiation of I + N. Best objective response was assessed by clinical chart review, imaging reports, and treating physician evaluation; progression-free survival (PFS) and overall survival (OS) were recorded as of 31 December 2020. Descriptive statistics were used to summarize patient characteristics and BM-related variables. Kaplan-Meier method and Mantel-Haenszel log-rank test were used to compare survival among groups. Cox regression univariable and multivariable models were used to correlate patient- and treatment-related variables to outcomes. RESULTS: Eighty patients with RCC and BM treated with I + N were identified. Patients were predominantly male and Caucasian presenting primarily with IMDC intermediate or poor-risk clear-cell RCC. Best response to I + N was progressive disease (46%), stable disease (28%), partial response (21%), and not evaluable (5%). Median PFS was 6.1 months (95% CI 3.8–8.9 months) with the majority of patients (65%) discontinuing I + N due to disease progression. Median OS was 25.6 months (95% CI 14.9–NA) with median follow-up of 25.2 months. A multivariable regression model for PFS showed several variables to be significantly associated with worse PFS including female gender [p = 0.02; hazard ratio (HR) 2.16; 95% CI 1.14–4.12], metastases to other sites (p = 0.006; HR 2.12; 95% CI 1.24–3.62) and presence of BM to ribs (p = 0.0007; HR 2.61; 95% CI 1.50–4.52). A multivariable Cox model of OS showed no prior radiation therapy to BM (p = 0.02; HR 2.17; 95% CI 1.13–4.17) and presence of liver metastases (p = 0.0006; HR 3.19; 95% CI 1.65–6.19) to be significantly associated with worse OS. CONCLUSION: RCC patients with ≥ 1 BM who received I + N therapy had a relatively low response rate, PFS, and OS. Strategies to improve outcomes in this subset of patients are needed. |
Databáze: | OpenAIRE |
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