19: From cytokine to immunotherapy: Improvements in overall survival in metastatic renal cell carcinoma in a real-life population in Austria upon 3 decades of follow-up
Location: Poster Hall, Board D2
Georgia Hutterer, MD; Thomas Bauernhofer, MD; Sascha Ahyai, MD; Richard Zigeuner, MD; Sebastian Mannweiler, MD; Jasmin Spiegelberg, MD; Martin Pichler, MD, MSc; Renate Pichler, MD, PhD; Hannah Fluhrer
Resident in Medical Oncology Division of Oncology, Department of Internal Medicine, Medical University of Graz Graz, Austria
Introduction: The treatment of metastatic renal cell carcinoma (mRCC) has drastically evolved over the last three decades starting with the treatment with cytokines over the introduction of tyrosine kinase inhibitors (TKIs) to modern immunotherapy. However, randomized controlled trials only report survival data of highly selected cohorts, thus the impact of novel therapeutic options on overall survival (OS) in real-life populations is unknown. Materials and
Methods: 914 mRCC patients who were diagnosed between July 1985 and September 2020, were included into this observational study and assigned to three different treatment eras (‘cytokine’, ‘1st generation TKIs’, ‘modern TKIs/immunotherapy’) based on the EMA-approval dates of sunitinib (July 2006) and nivolumab (June 2015) in mRCC treatment. OS was considered the primary study endpoint. Kaplan-Meier analyses, log-rank tests, as well as uni- and multivariable Cox regression models were implemented.
Results: There was a significant OS benefit for patients of the modern TKIs/immunotherapy era (median OS not reached) as compared to the cytokine (2.4 years) and 1st generation TKIs era (1.7 years, all p<0.001). In addition, Cox proportional hazard models demonstrated a significantly better prognosis for patients of the modern TKIs/immunotherapy era (HR=0.46, 95%CI=0.35-0.60, p<0.001) as compared to those of the cytokine era. No statistically significant difference was observed between the cytokine and the 1st generation TKIs era cohort. Additionally performed subgroup analyses stratified by the International Metastatic RCC Database Consortium (IMDC) risk groups showed significantly improved survival in the modern TKIs/immunotherapy era across all IMDC risk groups.
Conclusion: Both, significant advances in the systemic medical treatment of mRCC during the recent decade, as well as the introduction of immunotherapy exerted a major impact on patient outcomes in terms of OS in a real-life population.