Sarcomatoid RCC: dual checkpoint inhibition improves outcomes

  • Tannir NM & al.
  • Clin Cancer Res
  • 1 Sep 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Dual checkpoint inhibition with nivolumab+ipilimumab improves survival and response in patients with advanced renal cell carcinoma (RCC) with sarcomatoid features vs sunitinib monotherapy.
  • OS improved regardless of programmed death-ligand 1 (PD-L1) expression.

Why this matters

  • Patients with sarcomatoid features have poor prognosis.

Study design

  • Post hoc analysis of the phase 3 CheckMate 214 trial.
  • 139 patients with advanced RCC with sarcomatoid features were randomly assigned to nivolumab plus ipilimumab or sunitinib monotherapy.
  • Funding: Bristol Myers Squibb.

Key results

  • Minimum follow-up was 42 months.
  • Median OS significantly improved in the nivolumab+ipilimumab group:
    • Not reached vs 14.2 months with sunitinib;
    • HR, 0.45 (P=.0004).
  • PFS benefits with nivolumab+ipilimumab also seen:
    • Median, 26.5 vs 5.1 months with sunitinib;
    • HR, 0.54 (P=.0093).
  • Nivolumab+ipilimumab vs sunitinib:
    • Confirmed overall response rate: 60.8% vs 23.1%;
    • Complete response rate: 18.9% vs 3.1%.
  • OS improved with nivolumab+ipilimumab regardless of baseline PD-L1 expression:
    • Expression ≥1%: HR, 0.42 (P=.0260);
    • Expression
  • Grade 3-4 adverse event rate was 49% with nivolumab+ipilimumab vs 45% with sunitinib.
  • No new safety signals were reported.

Limitations

  • Limited power to detect differences according to baseline PD-L1 expression.