Background: In recent years, new therapeutic combinations based on immunotherapy provided significant benefits as a first-line treatment for patients with advanced renal cell carcinoma (mRCC).Objective: This work aims to address the lack of head-to-head comparisons and the uncertainty of the benefit from immunotherapy-based combinations in all the International Metastatic RCC Database Consortium (IMDC) subgroups.Design, setting, and participants: A systematic review and a network meta-analysis were performed. Overall survival (OS) in the intention-to-treat (ITT) population was the primary endpoint. OS according to IMDC subgroups (favorable, intermediate, poor), PD-L1 expression, and grade > 3 adverse events (AEs) were secondary endpoints. A SUCRA analysis was performed.Results and limitations: Six randomized phase III trials with 5121 patients were included. There was a high likelihood (82%) that nivolumab-cabozantinib was the preferred treatment in OS. The benefit of ICI-based combinations over sunitinib was unclear in the favorable-risk subgroup. Nivolumab-ipilimumab had the best risk/benefit ratio among all the ICI-based combinations. The limitations were the lack of individual patient data; the heterogeneity of patients' characteristics, trial designs, and follow-up times; and a limited number of studies for indirect comparisons.Conclusions: A customized approach for the first-line treatment of patients with mRCC should consider the risk/benefit profile of each treatment option, especially considering the likeliness of long-term survival finally reached in this setting.

Is there a preferred first-line therapy for metastatic renal cell carcinoma? A network meta-analysis / Cattrini, Carlo; Messina, Carlo; Airoldi, Chiara; Buti, Sebastiano; Roviello, Giandomenico; Mennitto, Alessia; Caffo, Orazio; Gennari, Alessandra; Bersanelli, Melissa. - In: THERAPEUTIC ADVANCES IN UROLOGY. - ISSN 1756-2872. - STAMPA. - 13:(2021), pp. 1-10. [10.1177/17562872211053189]

Is there a preferred first-line therapy for metastatic renal cell carcinoma? A network meta-analysis

Roviello, Giandomenico;
2021

Abstract

Background: In recent years, new therapeutic combinations based on immunotherapy provided significant benefits as a first-line treatment for patients with advanced renal cell carcinoma (mRCC).Objective: This work aims to address the lack of head-to-head comparisons and the uncertainty of the benefit from immunotherapy-based combinations in all the International Metastatic RCC Database Consortium (IMDC) subgroups.Design, setting, and participants: A systematic review and a network meta-analysis were performed. Overall survival (OS) in the intention-to-treat (ITT) population was the primary endpoint. OS according to IMDC subgroups (favorable, intermediate, poor), PD-L1 expression, and grade > 3 adverse events (AEs) were secondary endpoints. A SUCRA analysis was performed.Results and limitations: Six randomized phase III trials with 5121 patients were included. There was a high likelihood (82%) that nivolumab-cabozantinib was the preferred treatment in OS. The benefit of ICI-based combinations over sunitinib was unclear in the favorable-risk subgroup. Nivolumab-ipilimumab had the best risk/benefit ratio among all the ICI-based combinations. The limitations were the lack of individual patient data; the heterogeneity of patients' characteristics, trial designs, and follow-up times; and a limited number of studies for indirect comparisons.Conclusions: A customized approach for the first-line treatment of patients with mRCC should consider the risk/benefit profile of each treatment option, especially considering the likeliness of long-term survival finally reached in this setting.
2021
13
1
10
Cattrini, Carlo; Messina, Carlo; Airoldi, Chiara; Buti, Sebastiano; Roviello, Giandomenico; Mennitto, Alessia; Caffo, Orazio; Gennari, Alessandra; Bersanelli, Melissa
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1295685
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