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Ohba K, Nakanishi H, Kawada K, Nakamura Y, Mitsunari K, Matsuo T, Mochizuki Y, Imamura R. Predictive factors of nivolumab plus ipilimumab treatment efficacy in metastatic renal cell carcinoma patients. Jpn J Clin Oncol 2024; 54:827-832. [PMID: 38651176 PMCID: PMC11228832 DOI: 10.1093/jjco/hyae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Nivolumab plus ipilimumab is a recommended first-line therapy regimen for metastatic renal cell carcinoma. However, it is not clear which patient characteristics are associated with its effectiveness. METHODS We retrospectively examined 67 metastatic renal cell carcinoma patients treated with nivolumab plus ipilimumab as a first-line therapy in multiple institutions from September 2018 to August 2022. We analyzed the relationships between survival outcomes and patient-related variables, including paraneoplastic symptoms. We also analyzed the relationships between changes in symptoms and parameters and outcomes. RESULTS Of the 67 patients, 32 patients had paraneoplastic symptoms. The median progression-free survival was 14.9 months and median overall survival was 43.3 months. The objective response rate was 49.25% (33 patients), including two patients with complete response. Patients with cytoreductive nephrectomy, bone metastasis, high C-reactive protein levels and paraneoplastic symptoms were significantly correlated with short progression-free survival in the univariate analysis. Multivariate analysis of these factors showed that the presence of paraneoplastic symptoms at treatment initiation remained an independent predictor of progression-free survival. Of the 32 patients with paraneoplastic symptoms at treatment initiation, 12 patients had symptomatic improvement and 20 did not. The 1-year progression-free survival rates were significantly longer in improved patients compared with those with no improvement. CONCLUSIONS Patients without cytoreductive nephrectomy and with bone metastasis, liver metastasis, high C-reactive protein levels and paraneoplastic symptoms were significantly correlated with shorter progression-free survival. The presence of paraneoplastic symptoms was an independent predictor of progression-free survival. Improvement in paraneoplastic symptoms may reflect the treatment efficacy of nivolumab plus ipilimumab.
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Affiliation(s)
- Kojiro Ohba
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiromi Nakanishi
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Ken Kawada
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuichiro Nakamura
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Kensuke Mitsunari
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomohiro Matsuo
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasushi Mochizuki
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Ryoichi Imamura
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
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2
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Dai J, He B, Zhang Y, Zhang H, Hu X, Xu L, Ni Y, Zhang X, Sun G, Zeng H, Shen P, Liu Z. The survival benefit of metastasectomy for metastatic non-clear cell renal cell carcinoma: a retrospective cohort study. World J Urol 2024; 42:259. [PMID: 38662226 PMCID: PMC11045608 DOI: 10.1007/s00345-024-04973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The aim of this study was to explore the benefit the metastasectomy for patients with metastatic non-clear cell carcinoma (non-ccRCC). METHODS This study enrolled 120 patients with confirmed metastatic non-ccRCC from the RCC database of our center from 2008 to 2021. Patients without metastasectomy were grouped as radical nephrectomy without metastasectomy patients. The clinical outcomes included overall survival (OS) and progression-free survival (PFS). Cox regression and Kaplan-Meier analyses were used to assess potential factors that predict clinical benefits from metastasectomy. RESULTS A total of 100 patients received radical nephrectomy alone, while the remaining 20 patients underwent both radical nephrectomy and metastasectomy. There was no significant difference in age between the two groups. Out of 100 patients who underwent radical nephrectomy, 60 were male, and out of 20 patients who had both radical nephrectomy and metastasectomy, 12 were male. Patients who underwent systemic therapy plus radical nephrectomy and metastasectomy had significantly better PFS (27.1 vs. 14.0, p = 0.032) and OS (67.3 vs. 24.0, p = 0.043) than those who underwent systemic therapy plus radical nephrectomy alone. Furthermore, for patients without liver metastasis (n = 54), systemic therapy plus radical nephrectomy and metastasectomy improved both PFS (p = 0.028) and OS (p = 0.043). Similarly, for patients with metachronous metastasis, systemic therapy plus radical nephrectomy and metastasectomy improved both PFS (p = 0.043) and OS (p = 0.032). None of the patients experienced serious perioperative complications (Clavien-Dindo Classification ≥ III grade). CONCLUSION Metastasectomy in patients with metastatic non-ccRCC may provide clinical benefits in terms of improved PFS and OS, especially in patients without liver metastasis and those with metachronous metastasis.
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Affiliation(s)
- Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ben He
- Department of Urology, The Third People's Hospital of Chengdu/The Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610014, Sichuan, China
| | - Yaowen Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Haoran Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lijing Xu
- Department of Urology, Institute of Urology, West China Xiamen Hospital, Sichuan University, Xiamen, 361000, China
| | - Yuchao Ni
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Hakimi K, Saidian A, Panian J, Barata P, Berg S, Chang SL, Saliby RM, Dzimitrowicz H, Emamekhoo H, Gross E, Kilari D, Lam E, Nguyen M, Meagher M, Wang L, Rauterkus GP, D'Andrea V, Yim K, Psutka S, Thapa B, Weise N, Zhang T, McKay RR, Derweesh IH. Outcomes of Consolidative Nephrectomy following Primary Immunotherapy in Advanced Renal Cell Carcinoma: A Multicenter Analysis. Clin Genitourin Cancer 2023; 21:694-702. [PMID: 37558529 DOI: 10.1016/j.clgc.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/09/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND To evaluate effect and outcomes of combination primary immunotherapy (IO) and nephrectomy for advanced renal cell carcinoma (RCC). METHODS We conducted a multicenter, retrospective analysis of patients with advanced/metastatic RCC who received IO followed by nephrectomy. Primary outcome was Bifecta (negative surgical margins and no 30-day surgical complications). Secondary outcomes included progression-free survival (PFS) following surgery, reduction in tumor/thrombus size, RENAL score, and clinical/pathologic downstaging. Cox regression multivariable analysis was conducted for predictors of Bifecta and PFS. Kaplan-Meier analysis assessed PFS, comparing Bifecta and non-Bifecta groups. RESULTS A total of 56 patients were analyzed (median age 63 years; median follow-up 22.5 months). A total of 40 (71.4%) patients were intermediate IMDC risk. Patients were treated with immunotherapy for median duration of 8.1 months. Immunotherapy resulted in reductions in tumor size (P < .001), thrombus size (P = .02), and RENAL score (P < .001); 38 (67.9%) patients were clinically downstaged on imaging (P < .001) and 25 (44.6%) patients were pathologically downstaged following surgery (P < .001). Bifecta was achieved in 38 (67.9%) patients. Predictors for bifecta achievement included decreasing tumor size (HR 1.08, P = .043) and pathological downstaging (HR 2.13, P = .047). Bifecta (HR 5.65, P = .009), pathologic downstaging (HR 5.15, P = .02), and increasing reduction in tumor size (HR 1.2, P = .007) were associated with improved PFS. Bifecta patients demonstrated improved 2-year PFS (84% vs. 71%, P = .019). CONCLUSIONS Primary immunotherapy reduced tumor/thrombus size and complexity. Pathologically downstaged patients were more likely to achieve bifecta, and these patients displayed improved 2-year PFS. Our study supports further inquiry in the use of CRN following primary immunotherapy for advanced renal cancer.
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Affiliation(s)
- Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Ava Saidian
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Justine Panian
- Deparment of Internal Medicine, Division of Hematology and Medical Oncology, UC San Diego School of Medicine, San Diego, CA
| | - Pedro Barata
- Department of Hematology and Medical Oncology, Tulane University School of Medicine, New Orleans, LA
| | - Stephanie Berg
- Department of Hematology and Medical Oncology, Loyola University Medical Center, Maywood, IL
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Boston, MA
| | - Renee M Saliby
- Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Hamid Emamekhoo
- Department of Hematology and Medical Oncology, University of Wisconsin School of Medicine, Madison, WI
| | - Evan Gross
- Department of Hematology and Medical Oncology, University of Washington School of Medicine, Seattle, WA
| | - Deepak Kilari
- Division of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Elaine Lam
- Department of Hematology and Medical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Mimi Nguyen
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Margaret Meagher
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Luke Wang
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Grant P Rauterkus
- Department of Hematology and Medical Oncology, Tulane University School of Medicine, New Orleans, LA
| | - Vincent D'Andrea
- Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kendrick Yim
- Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Sarah Psutka
- Department of Hematology and Medical Oncology, University of Washington School of Medicine, Seattle, WA
| | - Bicky Thapa
- Division of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Nicole Weise
- Deparment of Internal Medicine, Division of Hematology and Medical Oncology, UC San Diego School of Medicine, San Diego, CA
| | - Tian Zhang
- Department of Hematology and Medical Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rana R McKay
- Deparment of Internal Medicine, Division of Hematology and Medical Oncology, UC San Diego School of Medicine, San Diego, CA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, San Diego, CA.
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4
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Kato R, Matsuura T, Maekawa S, Kato Y, Kanehira M, Takata R, Obara W. Site-specific patterns of early response to nivolumab plus ipilimumab therapy in advanced renal cell carcinoma patients compared with tyrosine-kinase inhibitors. Int Immunopharmacol 2022; 113:109443. [DOI: 10.1016/j.intimp.2022.109443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/24/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
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Jones JO, Ince WHJ, Welsh SJ, Stewart GD. Activity of Immunotherapy Regimens on Primary Renal Tumours: A Systematic Review. KIDNEY CANCER 2022. [DOI: 10.3233/kca-220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND: Immune checkpoint inhibitors (ICPIs) are widely used in treating metastatic renal cell carcinoma (RCC). Cytoreductive nephrectomy (CN) forms part of multimodality treatment in advanced disease, however there is no prospective evidence for its use in the ICPI era. Trials of neoadjuvant ICPIs in RCC are underway; understanding the anticipated effect of ICPIs on the primary tumour may help clinical decision making in both localised and advanced settings. METHODS: A systematic search (PubMed, Web of Science, clinicaltrials.gov) of English literature from 2012 to 2022 was performed according to PRISMA guidelines. 2,398 records were identified, 54 were included in the analysis. RESULTS: In the metastatic setting, response in the primary tumour (≥30% reduction in size) is seen in 33–56% of patients treated with dual ICPI or ICPI + VEGFR-TKI. Pathological complete response rates were 14% for patients undergoing CN after a period of ICPI therapy. In the neoadjuvant setting there is a single published trial of VEGFR-TKI + ICPI, 30% of patients had a≥30% reduction in size of the primary. This appears superior to single agent ICPI. Grade 3 adverse event rates are comparable to the metastatic setting. CONCLUSIONS: A period of ICPI combination therapy followed by nephrectomy may be considered for selected patients as a strategy to manage metastatic disease. In the neoadjuvant setting, it is not clear whether ICPI + VEGFR-TKI is superior to VEGFR-TKI alone. There is minimal data on whether either CN after ICPI in metastatic patients, or neoadjuvant ICPI therapy for localised disease, improves long term survival.
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Affiliation(s)
- James O. Jones
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | | | - Sarah J. Welsh
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Grant D. Stewart
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
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Yoshino M, Ishihara H, Nemoto Y, Nakamura K, Nishimura K, Tachibana H, Fukuda H, Toki D, Yoshida K, Kobayashi H, Iizuka J, Shimmura H, Hashimoto Y, Tanabe K, Kondo T, Takagi T. Therapeutic role of deferred cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with nivolumab plus ipilimumab. Jpn J Clin Oncol 2022; 52:1208-1214. [PMID: 35780441 DOI: 10.1093/jjco/hyac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To explore the therapeutic role of deferred cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with nivolumab plus ipilimumab. PATIENTS AND METHODS Forty-one patients with synchronous metastatic renal cell carcinoma who received nivolumab plus ipilimumab as first-line systemic therapy at our affiliated institutions were retrospectively evaluated. We focused on the prognosis, including tumor responses in primary kidney and metastatic lesions in patients treated with deferred cytoreductive nephrectomy. In addition, the overall survival according to nephrectomy status (i.e. deferred cytoreductive nephrectomy vs. upfront cytoreductive nephrectomy vs. without cytoreductive nephrectomy) was compared. RESULTS During a median follow-up period of 12.0 months, seven (30%) patients received deferred cytoreductive nephrectomy at a median time of 10.4 months after nivolumab plus ipilimumab initiation. All the patients showed tumor shrinkage in their primary kidney lesions, including six (86%) patients with ≥30% of shrinkage. Metastatic lesions were also shrunk by ≥30% in six (86%) patients, including two (29%) obtaining complete response. At the last time of follow-up, three (43%) patients were disease-free. The overall survival rate after nivolumab plus ipilimumab initiation tended to be higher in patients with deferred cytoreductive nephrectomy compared with those with upfront cytoreductive nephrectomy (1-year survival rate: 100% vs. 72.4%, P = 0.0587) and those without cytoreductive nephrectomy (vs. 58.2%, P = 0.0613). CONCLUSIONS The present retrospective data showed that deferred cytoreductive nephrectomy had the potential to exert a therapeutic effect in a subset of patients who obtained favorable tumor responses to nivolumab plus ipilimumab for a certain period. Prospective randomized clinical trials are needed to confirm the prognostic impact of deferred cytoreductive nephrectomy after frontline immunotherapy in synchronous metastatic renal cell carcinoma.
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Affiliation(s)
- Maki Yoshino
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Yuki Nemoto
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kazutaka Nakamura
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Urology, Jyoban Hospital, Iwaki, Japan
| | - Koichi Nishimura
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | | | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Daisuke Toki
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Yasunobu Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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