Abstract 1457P
Background
Historically, poorer outcomes are expected with BM in mRCC. With improved local therapies (LT) and advances in systemic therapies (ST) in recent years, we conducted a UK multicentre retrospective review of BM outcomes in mRCC.
Methods
15 UK centres conducted retrospective individual mRCC pts data review, who commenced first line ST (1L) between 01/01/2018 and 30/06/2021. BM, IMDC scores, ST, LT and outcomes were collected and analysed using Kaplan Meier Analysis. 1173 mRCC pts were analysed for BM status. At data cutoff, 105 pts had <6months (m) follow up from metastatic diagnosis (FUm), 405 pts <12m FUm, and 676 pts <24m FUm.
Results
556 of 1173 pts had brain imaging (BI) at any time (47.4%), of which 305 pts were asymptomatic at time of BI. 154 pts (13.1%) had a diagnosis of BM at any time, of which 123 pts were symptomatic at BM diagnosis (79.9%). 20 BM pts had neurosurgery (13.0%), of which 10 had surgery alone as LT. 39 BM pts underwent Stereotactic Radiosurgery (SRS), 9 BM pts received Whole Brain Radiotherapy (WBRT), and 1 BM pt had SRS+WBRT sequentially. 105 BM pts had no LT (68.2%). All 154 BM pts received 1L. 80 pts were diagnosed before 1L. 75 pts received ST before BM diagnosis (20 pts received 2 prior ST lines and 6 pts received 3 prior ST lines before BM). 44 pts received no further ST after BM, 79 pts received only 1 ST line after BM, 24 pts received 2 ST lines after BM, 7 pts received 3 ST lines after BM, and no pts received 4 or more ST lines after BM. Median OS after BM is 21.0m. 245 pts had BI at any time prior to completing 3m on 1L (20.9%), with 225 pts having BI +/-3m of 1L. 26 of 225 pts had BM (11.6%). Table: 1457P
Breakdown of incidence and OS by IMDC
| All pts | No BM | BM | ||||
| IMDC | % | OS(m) | % | OS(m) | % | OS(m) |
| Favourable | 20.5 | 33.8 | 22.5 | 30.7 | 13.0 | 65.8 |
| Intermediate | 48.3 | 26.7 | 49.0 | 25.3 | 59.1 | 31.7 |
| Poor | 24.0 | 20.9 | 25.1 | 20.3 | 24.7 | 24.1 |
| Missing | 7.1 | n/a | 3.4 | n/a | 3.2 | n/a |
Conclusions
In this analysis, the outcomes for BM mRCC pts in the modern era of immunotherapies and combination ST, are comparable to pts without BM. Use of refined modern LT and better ST in BM pts may explain the better than historical outcomes in this patient population, and supports incorporating routine BI in mRCC staging.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
G. Ratnayake: Financial Interests, Personal, Invited Speaker: BMS, Ipsen; Financial Interests, Personal, Sponsor/Funding: Janssen, Novartis, Merck, Pfizer; Financial Interests, Personal, Advisory Board: Merck. A. Challapalli: Financial Interests, Personal, Sponsor/Funding: Astellas, Bayer, BMS, EUSA Pharma, Janssen, Novartis, Pfizer, Sanofi; Financial Interests, Personal, Invited Speaker: Ipsen. J. McGrane: Financial Interests, Personal, Other, Stocks: GlaxoSmithKline; Financial Interests, Personal, Sponsor/Funding: Astellas, Bayer, BMS, GlaxoSmithKline, Merck, Pfizer; Financial Interests, Personal, Invited Speaker: Ipsen, GlaxoSmithKline; Financial Interests, Personal, Advisory Role: GlaxoSmithKline, Ipsen, Merck, Pfizer. R. Frazer: Financial Interests, Personal, Sponsor/Funding: BMS, Eisai, Novartis, Pfizer, Sanofi; Financial Interests, Personal, Invited Speaker: BMS, Ipsen; Financial Interests, Personal, Advisory Role: BMS, Ipsen, MSD, Novartis. D.S. Parslow: Financial Interests, Personal, Sponsor/Funding: BMS. A. Lydon: Financial Interests, Personal, Sponsor/Funding: BMS, Astellas, Amgen, Bayer; Financial Interests, Personal, Advisory Role: Roche. M. Tuthill: Financial Interests, Personal, Leadership Role: Personalised Medicine Limited; Financial Interests, Personal, Sponsor/Funding: BMS, Ipsen, Janssen, Lilly, Novartis, Pfizer, Roche, Vaccitech, EUSA; Financial Interests, Personal, Advisory Role: BMS, Ipsen, Janssen, Lilly, Novartis, Pfizer, Roche, Vaccitech; Financial Interests, Personal, Invited Speaker: Astellas, BMS, Eisai, Everything Genetic, Genomic Health, Janssen, Novartis, Pfizer, Roche. N. Charnley: Financial Interests, Personal, Sponsor/Funding: BMS, Ipsen, EUSA Pharma. J.M. Malik: Financial Interests, Personal, Advisory Board: AstraZeneca, BMS, Eisai, Merck, Pfizer; Financial Interests, Personal, Invited Speaker: Astellas, BMS, Eisai, Pfizer, EUSA Pharma, MSD. A. Bahl: Financial Interests, Personal, Sponsor/Funding: Bayer, BMS, Merck, Pfizer, Roche, Sanofi; Financial Interests, Institutional, Research Grant: Janssen, Sanofi; Financial Interests, Personal, Invited Speaker: Ipsen. All other authors have declared no conflicts of interest.