Background: The upfront treatment of metastatic renal cell carcinoma (mRCC) has been revolutionized by the introduction of immune-based combinations. The role of cytoreductive nephrectomy (CN) in these patients is still debated. The ARON-1 study (NCT05287464) was designed to globally analyze real-world data of mRCC patients receiving first-line immuno-oncology combinations. This sub-analysis is focused on the role of upfront or delayed partial or radical CN in three geographical areas (Western Europe, Eastern Europe, America/Asia). Materials and Methods: We conducted a multicenter retrospective observational study in mRCC patients treated with first-line immune combinations from 55 centers in 19 countries. From 1152 patients in the ARON-1 dataset, we selected 651 patients with de novo mRCC. 255 patients (39%) had undergone CN, partial in 14% and radical in 86% of cases; 396 patients (61%) received first-line immune-combinations without previous nephrectomy. Primary endpoint was overall survival (OS) while progression-free survival (PFS) and tumor response rate were secondary endpoints. Results: Median OS from the diagnosis of de novo mRCC was 41.6 months and not reached (NR) in the CN subgroup and 24.0 months in the no CN subgroup, respectively (p<0.001). Median OS from the start of first-line therapy was NR in patients who underwent CN and 22.4 months in the no CN subgroup (p<0.001). Patients who underwent CN reported longer OS compared to no CN in all the three geographical areas (Western Europe: NR vs 23.7 months, p<0.001; Eastern Europe: NR vs 29.8 months, p=0.005; America/Asia: 57.3 months vs 25.5 months, p<0.001). Conclusions: No significant differences in terms of patients’ outcome seem to clearly emerge in our analysis, even if the rate CN and the choice of the type of first-line immune-based combination varies across the different Cancer Centers participating in the ARON-1 project.
Geographical differences in the management of metastatic de novo Renal Cell Carcinoma in the era of immune-combinations with a focus on the role of cytoreductive nephrectomy: an analysis from ARON- 1 Project / Rizzo, M.; Mollica, V.; Incorvaia, L.; Galli, L.; Merler, S.; Iacovelli, R.; Chiari, R.; Zucali, P. A.; Scagliarini, S.; De Giorgi, U.; Berardi, R.; Procopio, G.; Atzori, F.; Buti, S.; Bamias, A.; Battelli, N.; Grande, E.; Porta, C.; Massari, F.; Santoni, M.. - In: TUMORI. - ISSN 0300-8916. - 109:2_suppl(2023), pp. A37.28-A37.28. [10.1177/03008916231203496]
Geographical differences in the management of metastatic de novo Renal Cell Carcinoma in the era of immune-combinations with a focus on the role of cytoreductive nephrectomy: an analysis from ARON- 1 Project.
Buti S.Investigation
;
2023-01-01
Abstract
Background: The upfront treatment of metastatic renal cell carcinoma (mRCC) has been revolutionized by the introduction of immune-based combinations. The role of cytoreductive nephrectomy (CN) in these patients is still debated. The ARON-1 study (NCT05287464) was designed to globally analyze real-world data of mRCC patients receiving first-line immuno-oncology combinations. This sub-analysis is focused on the role of upfront or delayed partial or radical CN in three geographical areas (Western Europe, Eastern Europe, America/Asia). Materials and Methods: We conducted a multicenter retrospective observational study in mRCC patients treated with first-line immune combinations from 55 centers in 19 countries. From 1152 patients in the ARON-1 dataset, we selected 651 patients with de novo mRCC. 255 patients (39%) had undergone CN, partial in 14% and radical in 86% of cases; 396 patients (61%) received first-line immune-combinations without previous nephrectomy. Primary endpoint was overall survival (OS) while progression-free survival (PFS) and tumor response rate were secondary endpoints. Results: Median OS from the diagnosis of de novo mRCC was 41.6 months and not reached (NR) in the CN subgroup and 24.0 months in the no CN subgroup, respectively (p<0.001). Median OS from the start of first-line therapy was NR in patients who underwent CN and 22.4 months in the no CN subgroup (p<0.001). Patients who underwent CN reported longer OS compared to no CN in all the three geographical areas (Western Europe: NR vs 23.7 months, p<0.001; Eastern Europe: NR vs 29.8 months, p=0.005; America/Asia: 57.3 months vs 25.5 months, p<0.001). Conclusions: No significant differences in terms of patients’ outcome seem to clearly emerge in our analysis, even if the rate CN and the choice of the type of first-line immune-based combination varies across the different Cancer Centers participating in the ARON-1 project.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
