The impact of firstline immunotherapy and tyrosine kinase inhibitors combinations versus sunitinib on clinical outcomes of favorable risk advanced renal cell carcinoma: A meta-analysis of randomized studies.

Abstract

e16504 Background: Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, with clear cell carcinoma being the predominant histological subtype. Recent clinical trials have established the combination of immunotherapy (IO) and tyrosine kinase inhibitors (TKIs) as a therapeutic approach to enhance anti-tumor efficacy, surpassing the outcomes achieved with Sunitinib monotherapy. Despite these advancements, the comparative efficacy of IO+TKIs versus Sunitinib alone in IMDC favorable risk advanced RCC patients remains uncertain. This meta-analysis aims to evaluate and synthesize existing evidence to determine the survival outcomes and therapeutic benefits of IO+TKIs compared to Sunitinib in this patient population. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of the English language, diagnosis of advanced RCC, randomized studies of IO+TKI versus Sunitinib, and studies that reported overall survival (OS) and progression-free survival (PFS) for the IMDC favorable risk group discretely. A meta-analysis using the fixed-effects and random-effects models was conducted. Results: Four randomized studies with a total of 839 patients were included. All studies reported OS and PFS for IMDC favorable risk advanced RCC. The IO+TKI regimens comprised: Avelumab+Axitinib, Nivolumab+Cabozantinib, Pembrolizumab+Lenvatinib, and Pembrolizumab+Axitinib. There was no OS benefit for IO+TKI when compared to Sunitinib (HR = 0.98, 95%CI: 0.72-1.31; I 2 = 0.00%). However, IO+TKI combinations had a better PFS than Sunitinib (HR = 0.65, 95%CI: 0.53-0.81; I 2 = 21.43%). Conclusions: This meta-analysis demonstrates that while first-line IO+TKI combinations significantly improve PFS compared to Sunitinib in IMDC favorable risk advanced RCC, they do not confer a statistically significant OS benefit. Nevertheless, this superior PFS observed with IO+TKI regimens suggests enhanced disease control, which is still a meaningful clinical outcome.