The efficacy of first-line (1L) immune checkpoint inhibitor (ICI) combination therapies among different subgroups of patients with metastatic renal cell carcinoma (mRCC) remains unclear. Using data from up-to-date clinical trials, researchers from the Mayo Clinic assessed the efficacy of ICI combination therapy as a 1L treatment for mRCC.
Researchers used the MEDLINE and Embase databases to search for relevant phase 2 and 3 randomized, controlled trials that assessed ICI combination therapies in 1L mRCC. Efficacy was reported by age (<65 years; >65 years), gender, programmed cell death 1 ligand 1 (PD-L1) receptor status, and International mRCC Database Consortium risk category (favorable; intermediate/poor [IP]).
Efficacy outcomes included overall survival (OS), progression-free survival, and objective response rate. A random-effects meta-analysis was conducted, and a P-value of interaction <0.1 indicated statistical significance.
In 6 trials that included a total of 5121 patients, ICI combinations improved OS in the overall and IP-risk (hazard ratio, 0.67; 95% CI, 0.60-0.75) populations compared with sunitinib, but not in the favorable-risk population (0.98; 0.76-1.27).
Female patients achieved a greater benefit with ICI combinations over male patients (females, 0.64; 0.53-0.77; males, 0.77; 0.69-0.86; P=.09), and younger patients had a significant OS benefit compared with older patients (<65 years, 0.64; 0.57-0.73; >65 years, 0.84; 0.69-1.01; P=.02).
Patients with mRCC and factors including female gender, younger age (<65 years), and IP disease risk may benefit more from ICI combination therapies.