转移性肾细胞癌患者从基线到开始使用尼伐单抗期间 IMDC 类别转变的预后影响：MEET-URO 15 研究子分析

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-11-10 DOI:10.1016/j.clgc.2024.102267

Brigida Anna Maiorano , Martina Catalano , Chiara Mercinelli , Giandomenico Roviello , Marco Maruzzo , Ugo De Giorgi , Silvia Chiellino , Andrea Sbrana , Luca Galli , Paolo Andrea Zucali , Cristina Masini , Emanuele Naglieri , Giuseppe Procopio , Sara Merler , Lucia Fratino , Cinzia Baldessari , Riccardo Ricotta , Veronica Mollica , Mariella Sorarù , Marianna Tudini , Sara Elena Rebuzzi

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引用次数: 0

摘要

导言国际转移性肾细胞癌数据库联盟（IMDC）评分是对转移性肾细胞癌（mRCC）患者进行分层的最重要的预后评分，有助于指导一线治疗的选择。方法Meet-URO 15 是一项意大利多中心研究，研究对象是接受 nivolumab 作为二线或后续治疗的 mRCC 患者。这项事后分析旨在根据从一线治疗（基线）到开始使用尼伐单抗期间IMDC类别的变化，评估作为主要终点的总生存期（OS）和无进展生存期（PFS），以及作为次要终点的总反应率（ORR）和疾病控制率（DCR）。结果492名患者被纳入分析。基线时，分别有165例（33.5%）、287例（58.3%）和40例（8.2%）患者的IMDC分类为良好、中等和较差。在使用 nivolumab 前，364 名患者（73.9%）的预后类别与基线时相同，27 名患者（5.5%）的预后有所改善，101 名患者（20.5%）的预后恶化。与恶化为中度/差的患者相比，预后稳定的患者的 mPFS（P = .01）和 mOS（P <.01）明显更长。与保持稳定/恶化的患者相比，在使用 nivolumab 前 IMDC 类别有所改善的中度/贫困患者的 mOS 也更长（分别为 P < .01 和 P = .04）。从基线到nivolumab期间IMDC类别保持稳定决定了有利患者的DCR更为一致（P = .03）。结论在我们的子分析中，IMDC风险类别的变化似乎是评估接受≥二线nivolumab治疗的mRCC患者预后的有用工具。

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Prognostic Impact of IMDC Category Shift From Baseline to Nivolumab Initiation in Metastatic Renal Cell Carcinoma: A Sub-Analysis of the MEET-URO 15 Study

Introduction

The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score is the most important prognostic score to stratify patients with metastatic renal cell carcinoma (mRCC), helping to guide treatment choice in first line. We hypothesized that IMDC change may also exert a prognostic role in subsequent lines of mRCC therapy.

Methods

Meet-URO 15 is a multicenter Italian study of patients with mRCC receiving nivolumab as a second or subsequent line of therapy. This posthoc analysis aimed to evaluate the overall survival (OS) and progression-free survival (PFS) from nivolumab start as primary endpoints, overall response rate (ORR) and disease-control rate (DCR) as secondary endpoints, according to the change in the IMDC category from the first-line setting (baseline) to nivolumab start. Patients with available prognostic IMDC category information at baseline and before nivolumab were included.

Results

492 patients were included in the analysis. At baseline, 165 (33.5%), 287 (58.3%), and 40 patients (8.2%) had favorable, intermediate, and poor IMDC categories, respectively. Before nivolumab, 364 patients (73.9%) remained in the same prognostic category as at baseline, 27 (5.5%) improved, and 101 (20.5%) deteriorated. Significantly longer mPFS (P = .01) and mOS (P < .01) were reached by patients with a stable favorable group compared to those worsening to intermediate/poor. A longer mOS was also achieved from intermediate/poor patients who improved their IMDC category before nivolumab compared to those remaining stable/worsening (P < .01 and P = .04, respectively). Maintaining IMDC category stability from baseline to nivolumab determined a more consistent DCR in favorable patients (P = .03). Overall, patients who improved their IMDC risk score reached better survival outcomes than those who remained stable/deteriorated.

Conclusions

In our sub-analysis, the shift in the IMDC risk category appears to be a helpful prognostic tool for assessing the outcomes of patients with mRCC treated with ≥2nd line nivolumab.

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.