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Poster display session

2076 - Outcomes of patients with metastatic renal cell carcinoma (mRCC) who were treated with second-line (2L) vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI) after first-line (1L) immune checkpoint inhibitor (ICI) therapy

Date

10 Sep 2017

Session

Poster display session

Presenters

Amishi Shah

Citation

Annals of Oncology (2017) 28 (suppl_5): v295-v329. 10.1093/annonc/mdx371

Authors

A.Y. Shah1, E.A. Lemke1, G. Jianjun1, A. Chandamohan1, M.T. Campbell1, A. Zurita Saavedra1, L. Xiao2, J. Wang1, P.G. Corn1, E. Jonasch1, P. Sharma1, N. Tannir1

Author affiliations

  • 1 Genitourinary Medical Oncology, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 2 Biostatistics, The University of Texas MD Anderson Cancer Center, 77030 - Houston/US
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Resources

Abstract 2076

Background

ICI therapy is an established strategy in mRCC after progressive disease on VEGFR-TKI. Little data exists in the reverse sequence on response rate, progression-free survival (PFS), safety, and tolerability of TKI after 1L ICI therapy.

Methods

This is a retrospective analysis of patients with mRCC treated from 2015 to present with 1L ICI, followed by 2L TKI. Response assessment was provided by a blinded radiologist using RECIST 1.1. Descriptive statistics, Fisher’s test and Wilcoxon rank sum test were used.

Results

We report on 27 clear-cell mRCC patients with follow-up of at least 8 weeks on TKI post 1L ICI. Median age at diagnosis was 58 years. 78% of patients had lung, 37% bone, 37% lymph node, and 7% liver metastasis. As 1L therapy, 7 patients received nivolumab, 17 received nivolumab + ipilimumab, and 3 received nivolumab + bevacizumab. All 27 patients had resolution of Grade 3/4 toxicities from ICI and progressive disease at the time of TKI initiation. Median time from discontinuation of ICI to initiation of TKI was 4.1 weeks (range 0-23.3 weeks). 11 patients (41%) had PR (8 of whom had ≥40% tumor reduction), and 16 (59%) had SD as best response to TKI. Median PFS was 10.0 months (95% CI 6.8, not applicable). 9 patients discontinued 2L TKI after a median of 26.3 weeks (range 4.6-44 weeks), 8 patients because of PD and 1 because of toxicity. 2 patients developed Grade 3 transaminitis and 3 patients Grade 3 hand-foot skin reaction. Age, sex, IMDC risk score, nephrectomy status, and TKI agent did not predict PR or SD.Table:

891P

VariableTotal n (%)PR (n)SD (n)P value
Male19 (70)7120.68
Female8 (30)44
Localized at presentation9 (33)720.01
Metastatic at Presentation18 (67)414
IMDC good risk4 (15)310.47
IMDC intermediate risk19 (70)712
IMDC poor risk4 (15)13
Nephrectomy21 (78)10110.35
Primary in-situ6 (22)15
Pazopanib8 (30)440.37
Axitinib12 (44)39
Cabozantinib7 (26)43

Conclusions

In this small retrospective study, we observed a high response rate (41%), median PFS 10 months, and manageable toxicity in patients with mRCC treated with TKI after ICI. No patients had outright PD on 2L TKI after ICI.

Clinical trial identification

Not applicable (retrospective study)

Legal entity responsible for the study

MD Anderson Cancer Center Dept of Genitourinary Medical Oncology

Funding

None

Disclosure

G. Jianjun: Travel/Honoraria & Consulting: AstraZeneca. M.T. Campbell: Consulting/advisory role: AstraZeneca, Eisai. A. Zurita Saavedra: Research support: Pfizer. E. Jonasch: Research funding: Exelixis, Pfizer, Novartis Honoraria: Bristol-Myers Squib, Eisai, Exelixis, Novartis, Pfizer. P. Sharma: Stock: Jounce, Kite Pharma, Evelo, Neon & Constellation Consulting/advisory role: Bristol-Myers Squib, GSK, AstraZeneca, Amgen, Constellation, Jounce, Kite Pharma, Evelo, Neon & EMC Serono Patents (spouse): Jounce, Merck, Bristol-Myers Squib. N. Tannir: Travel/Honoraria & Consulting: Bristol-Myers Squib, Exelixis, Nektar, Novartis, Pfizer, Argos, Calithera Research: Bristol-Myers Squib, Exelixis, Epizyme, Novartis, Miranti. All other authors have declared no conflicts of interest.

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