1904P - Treatment options and outcome of metastatic renal cell carcinoma patients with brain or bone metastases: A real-world evidence from a German retrospective multi-center analysis

Background

Brain (BM) and bone metastases (BOM) in renal cell carcinoma (RCC) are associated with poor outcome. We evaluated real-world treatment paradigms of RCC patients with BM and BOM.

Methods

We retrospectively analyzed RCC patients with BM and BOM treated at 9 German tertiary cancer centres from 2003 to 2023. Adverse events (AE) were reported according to CTCAE 5.0, objective response rate (ORR) according to local standard. Progression free survival (PFS) and overall survival (OS) were calculated from start of treatment to progression or death.

Results

We included 349 patients with a median age of 64 years (IQR 55-71). 93% of all patients had BOM, 15% BM and 8% both. Most patients (86%) had clear cell RCC, 5% of all patients had sarcomatoid differentiation. 82% of patients had an ECOG PS of 0/1. IMDC risk was favorable/intermediate/poor in 19/58/23%. 76% received prior nephrectomy. Patients with BOM received first-line IO-combinations in 64% (IO-IO: 39%, TKI-IO: 61%), TKI-monotherapy in 36%, while patients with BM received IO-combinations in 73% (IO-IO: 42%, TKI-IO: 58%) and TKI in 27%. IO-based first-line therapy increased from 2003 to 2023. AE of all grades occurred in 87% and 50% during IO-based therapy or TKI monotherapy, and CTCAE grade ≥ 3 in 44% or 21%. ORR and survival outcomes with median follow-up of 33 months (IQR 14-78) are described in table. 49% and 50% of all patients with BOM and BM received second-line treatment, with Cabozantinib (34%; 31%) and Nivolumab (19%, 27%) being the most common treatment options.

Table: 1904P

Conclusions

RCC patients with BOM and BM are increasingly treated with IO-combinations but lead to higher rates of AE grade ≥ 3. In patients with BOM, IO-TKI revealed higher ORR compared to IO-IO combination, but not in patients with BM. Small sample size and retrospective design are major limitations of our analysis. Prospective studies evaluating treatment options for BOM and BM in patients with RCC is critical.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

P. Paffenholz.

Funding

Has not received any funding.

Disclosure

P. Paffenholz: Financial Interests, Advisory Board: BMS, Janssen, Merck, Roche; Financial Interests, Invited Speaker: Apogepha, Astellas, BMS, Eisai, Ipsen, Janssen, Merck; Financial Interests, Funding: Astellas, AstraZeneca, Ipsen, Janssen, Medac, Merck. P. Ivanyi: Financial Interests, Coordinating PI: BMS, Bayer, Eisai, EMD Serono, Ipsen, Merck, Metaplan, MSD, Pfizer, Roche, Apogepha, AstraZeneca, Deciphera, Lilly, BB-Biontech. R. Wullenkord: Financial Interests, Advisory Board: Pfizer; Financial Interests, Funding: Astellas. S. Zschäbitz: Financial Interests, Advisory Board: Amgen, Bayer, BMS, Eisai, Janssen, MSD, Novartis, Pfizer; Financial Interests, Invited Speaker: Amgen, Bayer, BMS, Eisai, Janssen, MSD, Novartis, Pfizer; Financial Interests, Funding: Amgen, Astellas, AstraZeneca, Ipsen, Janssen, Merck, MSD, Pfizer. M. Schostak: Financial Interests, Personal, Advisory Board, and honoraria for speaking: AstraZeneca, BMS, Janssen, Merck, Sharp & Dome, Merck, Bayer Vital; Financial Interests, Personal, Advisory Board: Novartis, Roche; Financial Interests, Institutional, Local PI: AstraZeneca, Bayer Vital, BMS, Janssen, Merck, Ferring. K. Schlack: Financial Interests, Advisory Board: Apogepha, BMS, Eisai, EUSA Pharma, Ipsen, Merck, MSD, Novartis, Pfizer. All other authors have declared no conflicts of interest.