Meta-Analysis

Association between age and efficacy of first-line immunotherapy-based combination therapies for mRCC: a meta-analysis

https://orcid.org/0000-0002-7410-0712

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Department of Urology, The Jikei University School of Medicine, Tokyo, 105-8461, Japan

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Fahad Quhal

https://orcid.org/0000-0002-8163-6953

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Department of Urology, King Fahad Specialist Hospital, Dammam, 32253, Saudi Arabia

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Tatsushi Kawada

https://orcid.org/0000-0002-8369-9712

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Department of Urology, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical Sciences, Okayama, 700-8530, Japan

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Kensuke Bekku

https://orcid.org/0000-0003-0002-1592

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Department of Urology, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical Sciences, Okayama, 700-8530, Japan

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Ekaterina Laukhtina

https://orcid.org/0000-0002-8953-0272

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Institute for Urology & Reproductive Health, Sechenov University, Moscow, 119435, Russia

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Pawel Rajwa

https://orcid.org/0000-0003-4073-6584

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Department of Urology, Medical University of Silesia, Zabrze, 41-800, Poland

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Markus von Deimling

https://orcid.org/0000-0002-9954-3413

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, 20251, Germany

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Marcin Chlosta

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Clinic of Urology & Urological Oncology, Jagiellonian University, Krakow, 30-688, Poland

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Benjamin Pradere

https://orcid.org/0000-0002-7768-8558

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, 31130, France

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Pierre I Karakiewicz

Cancer Prognostics & Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, H2X 0A9, Canada

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Keiichiro Mori

https://orcid.org/0000-0002-6147-6569

Department of Urology, The Jikei University School of Medicine, Tokyo, 105-8461, Japan

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Takahiro Kimura

https://orcid.org/0000-0002-5673-1553

Department of Urology, The Jikei University School of Medicine, Tokyo, 105-8461, Japan

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Manuela Schmidinger

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

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Shahrokh F Shariat

*Author for correspondence:

E-mail Address: shahrokh.shariat@meduniwien.ac.at

https://orcid.org/0000-0002-6627-6179

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, 1090, Austria

Division of Urology, Department of Special Surgery, The University of Jordan, Amman, 19328, Jordan

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA

Department of Urology, Second Faculty of Medicine, Charles University, Prague, 15006, Czech Republic

Department of Urology, Weill Cornell Medical College, NY 10021, USA

Karl Landsteiner Institute of Urology & Andrology, Vienna, 1090, Austria

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Published Online:11 Sep 2023https://doi.org/10.2217/imt-2023-0039

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Abstract

Aim: To compare the efficacy of first-line immune checkpoint inhibitor (ICI)-based combinations in metastatic renal cell carcinoma (mRCC) patients stratified by chronological age. Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, hazard ratios for overall survival (OS) from randomized controlled trials were synthesized. Results: Five RCTs were eligible for meta-analyses. ICI-based combinations significantly improved OS compared with sunitinib alone, both in younger (<65 years) and older (≥65 years) patients, whereas the OS benefit was significantly better in younger patients (p = 0.007). ICI-based combinations did not improve OS in patients aged ≥75 years. Treatment rankings showed age-related differential recommendations regarding improved OS. Conclusion: OS benefit from first-line ICI-based combinations was significantly greater in younger patients. Age-related differences could help enrich shared decision-making.

Plain language summary

Scientists have found a special way to treat a type of cancer called metastatic renal cell carcinoma. They use a combination of medicines that help the body's immune system fight cancer. These treatments are very effective and recommended as the first choice for patients with this type cancer. However, as people get older, their immune systems may not work as well. Studies looking at how these treatments work in different age groups, and it was discovered that these treatments improved the chances of survival for all patients, no matter their age. However, they also noticed that younger patients got even more benefits from the treatments. Because of these discoveries, doctors can now make better decisions about which treatment to use for patients with this type of cancer, depending on patient age.

Tweetable abstract

We assessed the differential efficacy of first-line ICI-based combinations in mRCC patients stratified by chronological age. We found that ICI-based combinations improve overall survival (OS) in younger and older patients, whereas OS benefit was significantly more pronounced in younger patients.

Keywords:

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

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Vol. 15, No. 15

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History

Received 17 February 2023

Accepted 31 July 2023

Published online 11 September 2023

Published in print October 2023

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Keywords

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-2023-0039

Author contributions

T Yanagisawa contributed to protocol/project development, data collection and management, data analysis and manuscript writing/editing. F Quhal, T Kawada and K Bekku contributed to data analysis and manuscript writing/editing. E Laukhtina, P Rajwa, M von Deimling, M Chlosta, B Pradere, PI Karakiewicz, and K Mori contributed to manuscript writing/editing. T Kimura and M Schmidinger contributed to manuscript editing and supervision. SF Shariat contributed to supervision, protocol/project development/management and manuscript editing.

Financial & competing interests disclosure

S Shariat is paid as follows: Honoraria: Astellas, AstraZeneca, Bayer, BMS, Cepheid, Ferring, Ipsen, Janssen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, Richard Wolf, Roche, Sanochemia, Sanofi, Takeda, Urogen. Consulting or advisory role: Astellas, AstraZeneca, Bayer, BMS, Cepheid, Ferring, Ipsen, Janssen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, Richard Wolf, Roche, Sanochemia, Sanofi, Takeda, Urogen. Speakers’ bureau: Astellas, AstraZeneca, Bayer, BMS, Cepheid, Ferring, Ipsen, Janssen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, RichardWolf, Roche, Sanochemia, Sanofi, Takeda, Urogen, Movember Foundation. T Kimura is a paid consultant/advisor of Astellas, Bayer, Janssen and Sanofi. M Schmidinger received as follows: Honoraria for lectures of advisory boards from IPSEN, EXELIXIS, BMS, MSD, MERCK, EUSA, EISAI, ASTELLAS, JANSSEN. 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.

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