MP28-06 CLINICAL IMPLICATIONS AND PREDICTIVE FACTORS OF PRIMARY RESISTANCE TO NIVOLUMAB PLUS IPILIMUMAB THERAPY IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP28-06 CLINICAL IMPLICATIONS AND PREDICTIVE FACTORS OF PRIMARY RESISTANCE TO NIVOLUMAB PLUS IPILIMUMAB THERAPY IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA Kazuyuki Numakura, Shingo Hatakeyama, Yuya Sekine, Muto Yumina, Mizuki Kobayashi, Soki Kashima, Ryohei Yamamoto, Taketoshi Nara, Mitsuru Saito, Shintaro Narita, Chikara Ohyama, and Tomonori Habuchi Kazuyuki NumakuraKazuyuki Numakura More articles by this author , Shingo HatakeyamaShingo Hatakeyama More articles by this author , Yuya SekineYuya Sekine More articles by this author , Muto YuminaMuto Yumina More articles by this author , Mizuki KobayashiMizuki Kobayashi More articles by this author , Soki KashimaSoki Kashima More articles by this author , Ryohei YamamotoRyohei Yamamoto More articles by this author , Taketoshi NaraTaketoshi Nara More articles by this author , Mitsuru SaitoMitsuru Saito More articles by this author , Shintaro NaritaShintaro Narita More articles by this author , Chikara OhyamaChikara Ohyama More articles by this author , and Tomonori HabuchiTomonori Habuchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003256.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nivolumab plus ipilimumab (NIVO+IPI) is the established first-line treatment for patients with metastatic renal cell carcinoma (mRCC). Although median overall survival (OS) of mRCC expects nearly four years, almost 20% of patients showed primary resistance to NIVO+IPI. To know whom patients do not expect any benefit from NIVO+IPI must gather attention from clinicians. These patients might be better given other immune-oncological (IO) combination regimens to avoid wasting limited lifetime and unnecessary immune-related adverse events. We aimed to evaluate the risk factors of primary resistance to NIVO+IPI in patients with mRCC. METHODS: We retrospectively evaluated 89 patients with mRCC treated with NIVO+IPI from multiple institutes. Primary resistance was defined as a progressive disease diagnosed by the first imaging evaluation. The associations between clinical factors and primary progression disease (pPD) were analyzed. RESULTS: The median observation period was 15.1 months (1 to 74 months). A total of 18 pPD occurred (20%) after NIVO+IPI initiation. Patients experienced pPD showed extremely worse overall survival (hazard ratio 5.488, 95% confidence interval [CI] 2.418-12.457, p<0.001) (Figure 1). The univariate analysis resulted that male gender, high systemic immune inflammation index, high C-reactive protein, high neutrophil-lymphocyte ratio (NLR), and metastasis in lymph node (LN) were related to pPD. In multivariable analysis, the LN metastasis (odds ratio [OR] 4.277, 95%CI 1.330-13.752, p = 0.015) and NLR>3 (OR 5.981, 95%CI 1.219-29.356, p=0.028) were an independent risk factor of pPD (Table 1). All pPD patients had at least one risk or both. CONCLUSIONS: This retrospective study showed that LN metastasis and high NLR were associated with pPD independently in patients treated with NIVO+IPI as first-line therapy. These patients might better be treated with other IO combinations such as VEGFR-TKI+IO. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e371 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazuyuki Numakura More articles by this author Shingo Hatakeyama More articles by this author Yuya Sekine More articles by this author Muto Yumina More articles by this author Mizuki Kobayashi More articles by this author Soki Kashima More articles by this author Ryohei Yamamoto More articles by this author Taketoshi Nara More articles by this author Mitsuru Saito More articles by this author Shintaro Narita More articles by this author Chikara Ohyama More articles by this author Tomonori Habuchi More articles by this author Expand All Advertisement PDF downloadLoading ...