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Published online: 2024-11-20

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Outcomes of treatment, laboratory results, adverse effects, and tolerability of cancer treatment in patients with metastatic renal cell carcinoma treated with ipilimumab and nivolumab after cytoreductive nephrectomy

Maciej Michalak1, Anna Kopczyńska2, Andrzej Antczak1, Tomasz Milecki1, Piotr Tomczak2

Abstract

Introduction. This publication aims to present the results of a retrospective analysis of the treatment outcomes of patients with metastatic renal cell carcinoma (mRCC) treated with ipilimumab and nivolumab (IPI-NIVO) who underwent cytoreductive nephrectomy (CN), radical nephrectomy (RN) or nephron-sparing surgery (NSS) and in whom surgery was omitted.

Material and methods. The retrospective analysis includes the results of 34 patients treated and followed at the Institute of Oncology, Poznań University of Medical Sciences, from May 2022 to February 2024.

Results. Progression-free survival (PFS) was compared in two groups of patients — those who underwent CN (n = 8) and those who had no prior surgical treatment before IPI-NIVO (n = 12). There was a statistically significant difference in the length of PFS between the two groups compared in favour of patients who underwent CN before starting systemic treatment (p = 0.004). The majority of patients (n = 27) reported adverse events during IPI-NIVO treatment. There was no effect of CN performed before initiation of systemic treatment on the occurrence of adverse events during therapy (p = 0.677). The most common reasons for discontinuation of systemic treatment were the drugs adverse effects (n = 8) and disease progression (n = 7).

Conclusions. The results presented in the study suggest the important role of CN in the treatment of mRCC. Appropriate selection of patients suitable for CN is critical to achieving optimal treatment outcomes. Due to limited literature data, further studies are needed to evaluate the role and validity of performing CN in patients with mRCC treated with IPI-NIVO regimens.

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References

  1. Hsieh JJ, Purdue MP, Signoretti S, et al. Renal cell carcinoma. Nat Rev Dis Primers. 2017; 3: 17009.
  2. Lam JS, Shvarts O, Leppert JT, et al. Renal cell carcinoma 2005: new frontiers in staging, prognostication and targeted molecular therapy. J Urol. 2005; 173(6): 1853–1862.
  3. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17(6): 1471–1474.
  4. Amato RJ. Chemotherapy for renal cell carcinoma. Semin Oncol. 2000; 27(2): 177–186.
  5. Minasian LM, Motzer RJ, Gluck L, et al. Interferon alfa-2a in advanced renal cell carcinoma: treatment results and survival in 159 patients with long-term follow-up. J Clin Oncol. 1993; 11(7): 1368–1375.
  6. Passalacqua R, Buzio C, Buti S, et al. Phase III, randomised, multicentre trial of maintenance immunotherapy with low-dose interleukin-2 and interferon-alpha for metastatic renal cell cancer. Cancer Immunol Immunother. 2010; 59(4): 553–561.
  7. Leach DR, Krummel MF, Allison JP. Enhancement of antitumor immunity by CTLA-4 blockade. Science. 1996; 271(5256): 1734–1736.
  8. Hirano F, Kaneko K, Tamura H, et al. Blockade of B7-H1 and PD-1 by monoclonal antibodies potentiates cancer therapeutic immunity. Cancer Res. 2005; 65(3): 1089–1096.
  9. PDQ Adult Treatment Editorial Board. Renal Cell Cancer Treatment (PDQ®): Patient Version. In: PDQ Cancer Information Summaries [Internet]. National Cancer Institute (US), Bethesda (MD) 2022.
  10. Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015; 67(5): 913–924.
  11. Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011; 59(4): 543–552.
  12. Tan HJ, Norton EC, Ye Z, et al. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012; 307(15): 1629–1635.
  13. Motzer RJ, Tannir NM, McDermott DF, et al. CheckMate 214 Investigators. Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma. N Engl J Med. 2018; 378(14): 1277–1290.
  14. Lichtbroun BJ, Srivastava A, Doppalapudi SK, et al. New Paradigms for Cytoreductive Nephrectomy. Cancers (Basel). 2022; 14(11).
  15. Kumada N, Iinuma K, Kubota Y, et al. Impact of Cytoreductive Nephrectomy in the Management of Metastatic Renal Cell Carcinoma: A Multicenter Retrospective Study. Diseases. 2024; 12(6).
  16. Larcher A, Fallara G, Rosiello G, et al. Cytoreductive Nephrectomy in Metastatic Patients with Signs or Symptoms: Implications for Renal Cell Carcinoma Guidelines. Eur Urol. 2020; 78(3): 321–326.
  17. Zhu Z, Jin Y, Zhou J, et al. PD1/PD-L1 blockade in clear cell renal cell carcinoma: mechanistic insights, clinical efficacy, and future perspectives. Mol Cancer. 2024; 23(1): 146.
  18. Wu Ke, Li Y, Ma K, et al. The microbiota and renal cell carcinoma. Cell Oncol (Dordr). 2024; 47(2): 397–413.
  19. Liao Z, Wang D, Song N, et al. Prognosis of clear cell renal cell carcinoma patients stratified by age: A research relied on SEER database. Front Oncol. 2022; 12: 975779.
  20. Luo Z, Jiao B, Xu Q, et al. Do patients with metastatic renal cell carcinoma obtain survival benefits from cytoreductive nephrectomy? A population-based study. J Cancer Res Clin Oncol. 2023; 149(12): 9657–9670.