Impact of Impaired Renal Function on the Efficacy and Safety of Second-Line Tyrosine Kinase Inhibitor Therapy After First-Line Immuno-Oncology Combination Therapy in Metastatic Renal Cell Carcinoma: A Japanese Multicenter Retrospective Study.

IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY
Naoki Fujita, Yuto Matsushita, Takahiro Kojima, Yukari Bando, Takahiro Osawa, Tomokazu Sazuka, Keisuke Goto, Kazuyuki Numakura, Kazutoshi Yamana, Shuya Kandori, Yoshihide Kawasaki, Takuma Kato, Makito Miyake, Kazutoshi Fujita, Kosuke Ueda, Hajime Tanaka, Ryotaro Tomida, Hiroshi Kitamura, Hideaki Miyake, Shingo Hakakeyama
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引用次数: 0

Abstract

Objectives: To evaluate the effects of renal impairment at the time of second-line tyrosine kinase inhibitor (TKI) therapy initiation and rapid renal function decline during first-line immuno-oncology (IO) combination therapy on metastatic renal cell carcinoma (mRCC) patients treated with second-line TKIs.

Methods: This multicenter retrospective study included 243 mRCC patients treated with first-line IO combination therapy, followed by second-line TKI therapy. Patients were divided into three groups using the estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) at the time of second-line TKI therapy initiation: eGFR ≥ 60, 30 ≤ eGFR < 60, and eGFR < 30. The eGFR slope during first-line IO combination therapy was calculated using eGFR measurements when initiating first-line and second-line therapies. Multivariable Cox proportional hazards regression analyses were performed to evaluate the effects of renal impairment and eGFR slope on progression-free survival (PFS) and overall survival (OS).

Results: The incidence rates of any grade and grade ≥ 3 adverse events were not significantly different among the three groups. Univariable analyses indicated that eGFR slope was not significantly associated with PFS or OS. Multivariable analyses suggested that moderate (30 ≤ eGFR < 60 mL/min/1.73 m2) and severe (eGFR < 30 mL/min/1.73 m2) renal impairment had no effects on shorter PFS, whereas severe renal impairment was independently and significantly associated with shorter OS.

Conclusions: TKIs can be safely used as a second-line treatment after first-line IO combination therapy in mRCC patients with renal impairment without sacrificing oncological outcomes, except for in patients with severe renal impairment.

肾功能受损对转移性肾癌一线免疫肿瘤联合治疗后二线酪氨酸激酶抑制剂治疗的疗效和安全性的影响:一项日本多中心回顾性研究
目的:评价二线酪氨酸激酶抑制剂(TKI)治疗开始时肾脏损害的影响,以及二线TKI治疗的转移性肾癌(mRCC)患者在一线免疫-肿瘤(IO)联合治疗期间肾功能的快速下降。方法:本多中心回顾性研究纳入243例mRCC患者,采用一线IO联合治疗,随后采用二线TKI治疗。根据估计的肾小球滤过率(eGFR)将患者分为三组;mL/min/1.73 m2): eGFR≥60、30≤eGFR结果:三组间任何级别及≥3级不良事件发生率无显著差异。单变量分析表明,eGFR斜率与PFS或OS无显著相关。多变量分析表明,中度(30≤eGFR 2)和重度(eGFR 2)肾功能损害对较短的PFS没有影响,而重度肾功能损害与较短的OS独立且显著相关。结论:除了严重肾功能损害的mRCC患者外,TKIs可以安全地作为一线IO联合治疗后的二线治疗,而不会牺牲肿瘤预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Journal of Urology
International Journal of Urology 医学-泌尿学与肾脏学
CiteScore
4.70
自引率
11.50%
发文量
340
审稿时长
3 months
期刊介绍: International Journal of Urology is the official English language journal of the Japanese Urological Association, publishing articles of scientific excellence in urology. Submissions of papers from all countries are considered for publication. All manuscripts are subject to peer review and are judged on the basis of their contribution of original data and ideas or interpretation.
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