Regional experience of first-line therapy for metastatic renal cell carcinoma. Retrospective data analysis

   Introduction. Currently, immune and immune-targeted combinations are in the place of mRCC treatment for all prognosis groups, according to the world’s and national recommendations. These changes are associated with the results of pivotal studies, which proved the efficacy and safety of combinations of immuno-targeted or dual immunotherapy. Considering the changes in clinical recommendations, a retrospective analysis was initiated to assess the effectiveness of first-line therapy in patients with metastatic renal cell carcinoma (mRCC) in the Sverdlovsk Regional Oncology Dispensary.

   Results. The study included 950 patients from January 2021 to November 2024. The median follow-up time was 15 months. Most patients (69 %) had an intermediate and poor prognosis. 28.1 % of patients received combination treatment as the first line. The median PFS in the overall subgroup was 10.5 months. 1-year PFS was 46.5 %. The 2-year PFS was 22.2 %. 32 % patients received subsequent antitumor therapy. The ORR was 40 %, disease progression was recorded in 17 % of cases. The highest disease control rate (DCR) was recorded for combinations of nivolumab + ipilimumab, nivolumab + cabozantinib, lenvatinib + pembrolizumab.

   Conclusions. A change in the structure of the first-line therapy for mRCC was revealed towards a decrease in the prescription of monotherapy with tyrosine kinase inhibitors (TKI). The median OS, PFS is currently not reached in combinations group compared with monotherapy TKI. At the same time, one-year PFS tends to increase when using combinations of pembrolizumab + axitinib, pembrolizumab + lenvatinib. The best ORR rates were achieved in the nivolumab + cabozantinib, pembrolizumab + axitinib, pembrolizumab + lenvatinib, ipilimumab + nivolumab groups. A longer follow-up is required to conduct subgroup analyses and obtain PFS and OS data.

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