This study aimed to evaluate the treatment outcomes and safety of cabozantinib plus nivolumab (C + N) and lenvatinib plus pembrolizumab (L + P) for patients with metastatic renal cell carcinoma (mRCC). This multicenter retrospective analysis included 92 patients with mRCC treated with either C + N or L + P as first-line therapy between April 2018 and August 2024. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs) were compared. Multivariable analysis was performed to identify independent prognostic factors for PFS. Fifty-three patients received C + N and 39 received L + P. PFS (24.1 months vs. not reached, P = 0.725) and OS (46.7 months vs. not reached, P = 0.912) were not significantly different between the C + N and L + P groups. Over a median follow-up duration of 13.9 months, 31 patients experienced disease progression and 12 died. ORR was higher in the C + N group than in the L + P group (79% vs. 49%, P = 0.002), whereas DCR (100% vs. 95%, P = 0.096) and grade ≥ 3 TRAEs (47% vs. 36%, P = 0.280) were comparable. In the multivariable analysis, the treatment regimen (C + N as a reference) was not significantly associated with PFS (hazard ratio: 0.76, P = 0.476). Favorable/intermediate International mRCC Database Consortium risk was identified as an independent prognostic factor for PFS. Treatment with C + N and L + P resulted in comparable PFS, OS, and safety profiles in patients with mRCC. Both regimens can be used to treat mRCC based on individual characteristics.
Nakamura et al. (2026) studied this question.