Pd18-04 Survival Is Dramatically Improved for MRCC Patients With Sarcomatoid Features Who Are Treated With Cytoreductive Nephrectomy and Immune Checkpoint Inhibitors Regardless of Treatment Sequence

You have accessJournal of UrologyKidney Cancer: Advanced (Including Drug Therapy) II (PD18)1 May 2024PD18-04 SURVIVAL IS DRAMATICALLY IMPROVED FOR MRCC PATIENTS WITH SARCOMATOID FEATURES WHO ARE TREATED WITH CYTOREDUCTIVE NEPHRECTOMY AND IMMUNE CHECKPOINT INHIBITORS REGARDLESS OF TREATMENT SEQUENCE Daniel D. Shapiro, Jose A. Karam, Viraj A. Master, Philippe E. Spiess, Charles C. Peyton, Sarah P. Psutka, Jay D. Raman, Chiara Mercinelli, Edouard Nicaise, Nicholas D. Robertson, R. Barry Sirard, Amber Jani, Andrea Necchi, Wade J. Sexton, Brandon J. Manley, Dattatraya Patil, Glenn O. Allen, Surena F. Matin, and Edwin J. Abel Daniel D. ShapiroDaniel D. Shapiro , Jose A. KaramJose A. Karam , Viraj A. MasterViraj A. Master , Philippe E. SpiessPhilippe E. Spiess , Charles C. PeytonCharles C. Peyton , Sarah P. PsutkaSarah P. Psutka , Jay D. RamanJay D. Raman , Chiara MercinelliChiara Mercinelli , Edouard NicaiseEdouard Nicaise , Nicholas D. RobertsonNicholas D. Robertson , R. Barry SirardR. Barry Sirard , Amber JaniAmber Jani , Andrea NecchiAndrea Necchi , Wade J. SextonWade J. Sexton , Brandon J. ManleyBrandon J. Manley , Dattatraya PatilDattatraya Patil , Glenn O. AllenGlenn O. Allen , Surena F. MatinSurena F. Matin , and Edwin J. AbelEdwin J. Abel View All Author Informationhttps://doi.org/10.1097/01.JU.0001008596.32809.c5.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metastatic renal cell carcinoma (mRCC) tumors with sarcomatoid dedifferentiation are rare, and sarcomatoid features are historically associated with very poor outcomes. This study aimed to compare survival among sarcomatoid mRCC patients treated with either targeted therapy or immune checkpoint inhibitors (IO) and determine if the sequence of CN and systemic therapy was associated with survival. METHODS: Data from mRCC patients who underwent CN at 8 institutions from 2006-2022 were analyzed. Patients were categorized into 4 cohorts by type of systemic therapy they received and sequence of treatments: upfront IO+deferred CN (IO+CN), upfront targeted therapy+deferred CN (targeted+CN), upfront CN+deferred IO (CN+IO), or upfront CN+deferred targeted therapy (CN+targeted). Multivariable Cox regression evaluated variable associations with overall survival (OS). RESULTS: A total of 309/1421 (22%) mRCC patients treated with CN had sarcomatoid features identified on surgical pathology. Median age was 68, 29% were female, and most patients had clear cell RCC subtype (77%). The median follow-up was 37 months. Compared to a cohort of 1112 CN patients without sarcomatoid features, patients with sarcomatoid features had significantly shorter overall survival (median 15 vs 37 months, p<0.001).Treatment sequence was: upfront CN+targeted (60%), upfront CN+IO (19%), upfront targeted+CN (14%) and upfront IO+CN (7%). Patients treated with IO therapy at any time had significantly improved OS compared to patients not treated with IO (median 40 vs 13 months, p=0.0001). Among patients receiving targeted therapy, upfront CN was associated with reduced mortality (HR 0.6 95%CI 0.4-0.9 p=0.03). Among patients receiving IO therapy, the sequence of systemic therapy and CN was not associated with survival (p=0.7) (Figure 1). CONCLUSIONS: Immune checkpoint inhibitors have significantly improved survival for mRCC patients with sarcomatoid features treated with CN, regardless of timing of surgery. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e433 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Daniel D. Shapiro More articles by this author Jose A. Karam More articles by this author Viraj A. Master More articles by this author Philippe E. Spiess More articles by this author Charles C. Peyton More articles by this author Sarah P. Psutka More articles by this author Jay D. Raman More articles by this author Chiara Mercinelli More articles by this author Edouard Nicaise More articles by this author Nicholas D. Robertson More articles by this author R. Barry Sirard More articles by this author Amber Jani More articles by this author Andrea Necchi More articles by this author Wade J. Sexton More articles by this author Brandon J. Manley More articles by this author Dattatraya Patil More articles by this author Glenn O. Allen More articles by this author Surena F. Matin More articles by this author Edwin J. Abel More articles by this author Expand All Advertisement PDF downloadLoading ...