Abstract 1463P
Background
BMs are associated with higher morbidity and mortality in mRCC patients. With the evolution of systemic therapies (ST), we conducted a UK multicentre retrospective review of outcomes in mRCC pts with BM.
Methods
1246 mRCC pts data from 15 UK centres, who commenced first line ST between 01/01/18 and 30/06/21 were reviewed. Data on BM, IMDC scores, ST, local therapies (LT) were collected. Progression free survival (PFS) & Overall survival (OS) were calculated as time between start of 1st ST and subsequent ST/ date of progression & date of death/last follow-up, respectively. PFS & OS were analysed using Kaplan Meier Analyses (log rank test).
Results
353 (28%) pts had BM (62 bone only; 291 bone & visceral mets) with a median age of 65 (range: 27-90). 102 pts had LT (resection-25, stereotactic radiotherapy (RT)-4, palliative RT-72, vertebroplasty-1). 20 patients presented with cord compression. The IMDC risk groupings were favourable 48, intermediate 195, and poor 109. Pts just receiving 1, 2, 3 or more lines of ST were 171, 125, & 55, respectively. PFS was similar for the different ST (tyrosine kinase inhibitors (TKI), immunotherapy (IO), IO/TKI) either in 1st, 2nd or 3rd line therapies, or between patients with bone only or bone & visceral metastases (all risk groups). In intermediate & poor risk groups there was a trend in favour of PFS advantage with single agent TKI or IO/TKI compared to IO/IO (Table). The median OS of all BM pts was 21. The OS was significantly longer in the favourable IMDC group (favourable-34.4m vs. intermediate-24m vs. poor-8.7m; p<0.0001), pts with prior nephrectomy (32.7 vs. 16.4m; p<0.0001) and pts with bone only metastases (29.9 vs.19.7m; p<0.05). Table: 1463P
Median PFS: Intermediate & poor risk pts
| Cabozantinib | Other TKI | Ipi/Nivo | IO/TKI | Nivo | |
| Bone only metastases (n=51) | |||||
| First-line | 17.1 | 14.6 | 4.6 | 14.7 | |
| Second-line | Not reached | 9.1 | - | - | 2.1 |
| Bone + visceral metastases (n=254) | |||||
| First-line | 8.9 | 5.6 | 7.1 | 8.8 | |
| Second-line | 7.1 | 6.1 | - | - | 3.6 |
Conclusions
Our analyses indicate that TKIs remain a standard of care in mRCC pts with BM and OS is consistent with published literature. The PFS in intermediate and poor risk mRCC pts with BM favours TKI based ST compared to IO/IO treatment.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A. Challapalli: Financial Interests, Personal, Speaker’s Bureau, Conference sponsorship: Ipsen, Eisai, Pfizer, Merck; Financial Interests, Personal, Speaker’s Bureau: BMS, Eusa. G. Ratnayake, J. McGrane, R. Frazer, J.M. Malik: Financial Interests, Personal, Speaker’s Bureau: Ipsen. D.S. Parslow: Financial Interests, Personal, Speaker’s Bureau: BMS. A. Sharma: Financial Interests, Personal, Advisory Board: Pfizer, BMS, MSD, Merck; Financial Interests, Personal, Invited Speaker: Ipsen, Eisai. M. Tuthill: Financial Interests, Personal, Speaker’s Bureau: Ipsen, BMS. J.E. Brown: Financial Interests, Personal, Advisory Board: Ipsen, MSD; Financial Interests, Institutional, Research Grant: AstraZeneca. A. Bahl: Financial Interests, Personal, Speaker’s Bureau: Ipsen, BMS; Financial Interests, Institutional, Research Grant: Novartis. All other authors have declared no conflicts of interest.