Research Article

Efficacy of second-line ICIs combined with TKIs among patients with metastatic renal cell carcinoma: a real-world study

https://orcid.org/0000-0001-5346-8828

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

Department of Plastic Surgery & Burns, West China Hospital, Sichuan University, Chengdu, 610041, China

‡Authors contributed equally

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Junru Chen‡

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

‡Authors contributed equally

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Xingming Zhang‡

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

‡Authors contributed equally

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Xudong Zhu

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Zilin Wang

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Guangxi Sun

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Jiayu Liang

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Yuntian Chen

Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Yali Shen

Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, 610041, China,

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Jiyan Liu

Department of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China

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Xiang Li

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Qiang Wei

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Zhenhua Liu

*Author for correspondence: Tel.: +86 18 60 803 3400;

E-mail Address: Zhliu@scu.edu.cn

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Hao Zeng

**Author for correspondence: Tel.: +86 18 98 060 2129;

E-mail Address: kucaizeng@163.com

https://orcid.org/0000-0002-1267-0509

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Pengfei Shen

^***Author for correspondence: Tel.: +86 18 98 060 6710;

E-mail Address: cdhx510@163.com

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

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Published Online:21 Feb 2022https://doi.org/10.2217/imt-2021-0108

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Abstract

Aim: To evaluate the efficacy of immune checkpoint inhibitors (ICIs) plus tyrosine kinase inhibitors (TKIs) as second-line treatment in patients with metastatic renal cell carcinoma (mRCC). Patients & methods: Baseline and follow-up data from patients with mRCC treated with second-line ICIs plus TKIs or TKIs alone from a single institution were retrospectively gathered. Results: A total of 110 patients were included. The objective response rate was higher among patients treated with ICIs plus TKIs than those treated with TKIs alone (36.5 vs 12.1%; p = 0.002). Treatment with ICIs plus TKIs was associated with longer progression-free survival (15.0 vs 9.0 months; p = 0.009) and overall survival (not reached vs 16.0 months; p = 0.018) than TKI monotherapy. The survival rates at 2 (83.0 vs 74.4%; p = 0.426) and 3 years (58.1 vs 47.5%; p = 0.214) between the two groups were not statistically different. Notably, patients with certain clinicopathological features tended to gain more survival benefits with combined therapy. Conclusion: ICIs plus TKIs showed superior progression-free survival time and tumor response rate over TKIs alone as second-line treatment in patients with mRCC. Future randomized prospective trials are necessary to validate these preliminary findings.

Plain language summary

Aim: To evaluate the efficacy of immune checkpoint inhibitors (ICIs) combined with tyrosine kinase inhibitors (TKIs) in patients with previously treated metastatic renal cell carcinoma (mRCC). Patients & methods: Data at initial treatment and follow-up of patients with mRCC with second-line ICIs plus TKIs or TKIs alone were documented. Results: A total of 110 patients were included. The tumor shrinkage rate was higher among patients treated with ICIs plus TKIs than those treated with TKIs alone. Patients receiving ICIs plus TKIs had delayed disease progression and longer survival time compared with patients treated with TKI monotherapy. However, patients had a similar probability of survival after 2 and 3 years of treatment. Notably, patients with certain clinicopathological characteristics gained more survival benefits from ICIs plus TKIs. Conclusion: ICIs plus TKIs showed superior efficacy over TKIs alone in previously treated patients with mRCC. Future randomized prospective trials are necessary to validate these preliminary findings.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 14, No. 5

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History

Received 29 April 2021

Accepted 7 December 2021

Published online 21 February 2022

Published in print April 2022

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Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/imt-2021-0108

Author contributions

P Shen, H Zeng, Z Liu and H Zhang: conception and design. X Zhu. Z Wang, Y Chen, Y Shen and J Liu: data collection and assembly. H Zhang, J Chen and X Zhang: manuscript preparations. G Sun, J Liang, X Li and Q Wei: data analysis and interpretation. P Shen and H Zeng: principal investigator.

Acknowledgments

The authors sincerely wish to thank all of the patients and their families who agreed to be involved in this study.

Financial & competing interests disclosure

This work was supported by the National Natural Science Foundation of China (NSFC 81974398 and 81902577), China Postdoctoral Science Foundation (2021M692286), Post-Doctor Research Project, West China Hospital, Sichuan University (2021HXBH036), and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

Our study was approved by The Biomedical Ethics Committee of West China Hospital, Sichuan University (approval no. 2012 (15)). All patients provided written informed consent prior to enrollment in the study.

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