medwireNews: Real-world study data show that first-line immunotherapy alone or in combination with targeted therapy is associated with better overall survival (OS) than targeted therapy alone in people with metastatic clear cell renal cell carcinoma (RCC).
Nicholas Chakiryan (H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA) and co-investigators say that their findings “provide external validation for the OS benefit” observed with immunotherapy in recent clinical trials in this field.
Chakiryan and team performed a retrospective propensity-matched cohort study among 5872 patients with metastatic clear cell RCC in the US National Cancer Database who received first-line targeted therapy (n=4755), immunotherapy (n=638), or a combination of the two (n=479) outside of a clinical trial between 2015 and 2017.
They observed that patients who received immunotherapy or combination therapy were significantly younger than those who received targeted therapy, had significantly fewer comorbid conditions, and were significantly more likely to be treated at academic centers.
After accounting for these differences through propensity score matching, which resulted in three equal groups of 479 patients, the team found that first-line immunotherapy was associated with a significant 40% lower risk for death relative to targeted therapy in the median 9.6-month follow-up period.
The combination of immunotherapy plus targeted therapy was associated with a significant 26% lower mortality risk compared with targeted therapy alone, but there was no significant difference in survival between the immunotherapy alone and combination therapy groups.
The researchers estimated that the 12-month OS rates were 73% with immunotherapy, 68% with combination therapy, and 59% with targeted therapy.
Writing in JAMA Network Open, Chakiryan et al comment that their study confirms the findings of the CheckMate 214 and KEYNOTE-426 clinical trials, with a similar effect size, but note that the 12-month OS rates were much lower than those observed in these trials.
They believe this shows “that patients enrolled into clinical trials tend to be at a lower overall risk of mortality than those encountered in real-world clinical practice, regardless of treatment received,” which emphasizes “the importance of studying more generalizable populations.”
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