1711P - Real-word data challenging the treatment paradigm in metastatic renal cancer: Time to separate IMDC intermediate / poor risk groups?

Background

In the current landscape IMDC prognostic group has been used as a surrogate for treatment choices in 1^st line metastatic renal cell carcinoma (mRCC) in clinical trials. This has resulted in distinction between IMDC intermediate & poor risk (IR/PR) group compared to IMDC favourable risk (FR) group wherein, IR/PR IMDC groups get analysed as one treatment group. With clinical equipoise with IOTKI and IOIO in IR/PR group, we have dissected outcomes of 1^st line systemic anticancer therapy (SACT) in mRCC by IMDC groups.

Methods

Multicentre retrospective study (UKROC) of patients commencing SACT for mRCC between 01/01/2018-30/06/2021 at 17 UK NHS trusts. Patient demographics, tumour histology and IMDC group were analysed. Overall survival (OS) and progression free survival (PFS) were compared using Kaplan-Meier curves and the statistical significance of differences in outcome between the IMDC groups was assessed with the cox-regression testing, stratified by 1^st line SACT choice.

Results

1319 patients were identified with a median age of 64 years. 294 (22.3%), 695 (52.7%), 321 (24.3%) patients were IMDC FR, IR and PR respectively. 311, 196 and 778 patients received IOIO, IOTKI and single agent TKI respectively in the 1^st line setting (total=1286). IMDC PR In the IOIO group 30.9% of patients were IMDC PR compared to 17.3% and 23.8% in IOTKI and TKI groups respectively. In the IMDC PR group, there was a statistically significant OS advantage of IOIO compared to IOTKI and TKI therapy. Median OS was IOIO (21.8m), IOTKI (7.3m), TKI (8.6m). HR = 0.48 in favour of IOIO compared to IOTKI [CI 0.3-0.78]. Median PFS was IOIO (6.5m), IOTKI (4.2m), TKI(4.1) – not significant. IMDC IR No major statistical OS difference between treatment groups however, IOTKI was numerically trending higher - IOTKI (NR), IOIO (27.6m), TKI (22.2m). Median PFS in intermediate – IOTKI (11.7m), IOIO (7.6m), TKI (7.6m) – not significant.

Conclusions

In the IMDC PR group we have demonstrated a significant OS benefit for IOIO compared to IOTKI. In the IMDC IR group there is a trend in favour of IOTKI over other treatments. This suggests that the IMDC groups should be viewed separately for treatment and IO/IO should be the standard of care in the real world for IMDC PR mRCC patients.

Clinical trial identification

UK Renal Oncology Collaborative - Real world review of therapy choices and outcomes in metastatic renal cancer; REC reference:24/SC/0038; Protocol number: V0.2; IRAS project ID: 338935 Health Research Authority – NHS.

Editorial acknowledgement

Legal entity responsible for the study

Royal Cornwall Hospital.

Funding

Has not received any funding.

Disclosure

J. McGrane: Financial Interests, Institutional, Invited Speaker, Astellas, Beyer, Bristol Myers Squibb, Eisai, GSK, Janssen-Cilag, Ipsen, Pfizer, Merck, MSD, Roche: Royal Cormwall Hospital. R. Frazer: Financial Interests, Advisory Board, BMS, Ipsen, Merck, MSD, Novartis, Pfizer, Pierre Fabre, Roche, Sanofi, Servier: Velindre Cancer Centre Cardiff. A. Challapalli: Financial Interests, Advisory Board, Bayer, Astellas, Janssen, Pfizer, BMS, Ipsen, Novartis, Eusa, Eisai Ltd, Merck: Royal Bristol Infirmary. M. Tuthill: Financial Interests, Advisory Board, Eisai, BMS: Oxford NHS Trust. C. Forde: Financial Interests, Advisory Board, Ipsen, MSD: Belfast City Hospital. J.M. Malik: Financial Interests, Advisory Board, AstraZeneca, Bristol Myers Squibb, Eisai, Merck-Pfizer, Ipsen, Eusa Pharma, MSD, Pfizer, Astellas: Western General Hospital, Edinburgh. D. Parslow: Financial Interests, Advisory Board, BMS: University Hospital Plymouth. D. Lee: Financial Interests, Advisory Board, 1. Associate Professor of Health Economics and Health Policy 2. PenTAG, University of Exeter 3. Employee of University of Exeter who receive funding from the NIHR to undertake NICE appraisals including the pathways pilot in RCC: University of Exeter. All other authors have declared no conflicts of interest.