Abstract 739P
Background
The prognostic impact of previous cytoreductive nephrectomy (CN) and radical nephrectomy (RN) with curative intent in patients (pts) treated with IO is not well defined. Therefore, the aim of this study was to investigate the impact of previous nephrectomy in this patient population in a real-world setting.
Methods
Data for 287 eligible pts, with a least one radiological assessment according to the RECIST 1:1 criteria, were retrospectively collected from 16 Italian referral centres. Baseline characteristics, outcome data - including progression-free survival (PFS) and OS - were collected. Kaplan-Meier method and log-rank test were performed to compare PFS and OS between groups.
Results
195 (68%) pts received IO as second line therapy, 73 (25.4%) as third line and 19 (6.6%) pts as further line. 82 pts (28.6%) were classed as good risk, 176 (61.3%) were intermediate and 29(10.1%) were poor risk according to IMDC risk score. 246 (85.7%) pts underwent nephrectomy (of them, 95 (33.1%) pts had synchronous metastatic disease and underwent CN), while 41(14.2%) pts did not. Nephrectomy was performed before IO treatment. ECOG PS, at the beginning of IO, was 0 for 145 pts (50.5%), 116 (40.4%) had ECOG PS 1 and 26 (9%) had ECOG PS 2. At a median follow up of 24.7 months (mo), at the end of IO treatment 161/287 pts (56%) received mTOR and VEGFR inhibitors whereas 89/287 pts (31%) did not receive further treatment for clinical deterioration. 68/287 pts (23.7%) continued IO beyond progression. Median OS in pts who had previous nephrectomy was 20.9 mo vs 13 mo in pts who did not (HR 0.51; 95%CI 0.308 to 0.845; P=0.0007 for comparison) whereas mPFS was 4.9 mo vs 3.7 mo, respectively (HR 0.78; 95%CI 0.53 to 1.15; P=0.17). In pts with synchronous metastatic disease (136/287) who underwent CN, mOS was 20.5 mo vs 13 mo in metastatic pts who did not (HR 0.51; 95%CI 0.305 to 0.855; P=0.0024 for comparison), whereas mPFS was 4.61 mo vs 3.75 mo, respectively (HR 0.83; 95%CI 0.554 to 1.247; P=0.34).
Conclusions
A previous nephrectomy, including CN, was associated with a better outcome in terms of OS in pts receiving IO therapy.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
MeetUro network.
Funding
Has not received any funding.
Disclosure
S. Buti: Advisory/Consultancy, Speaker Bureau/Expert testimony: BMS; Advisory/Consultancy, Speaker Bureau/Expert testimony: pfizer; Advisory/Consultancy, Speaker Bureau/Expert testimony: MSD; Advisory/Consultancy, Speaker Bureau/Expert testimony: Ipsen; Advisory/Consultancy, Speaker Bureau/Expert testimony: AstraZeneca; Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis. G. Procopio: Advisory/Consultancy: Ipsen,; Advisory/Consultancy: Pfizer; Advisory/Consultancy: Novartis; Advisory/Consultancy: BMS; Advisory/Consultancy: Janssen. All other authors have declared no conflicts of interest.