Prognostic value of type of prior TKI in pretreated metastatic renal cell carcinoma patients receiving nivolumab

Aim: To define the prognostic significance of first-line TKI in mRCC patients receiving nivolumab.Materials and methods: A total of 571 mRCC patients who received >= second line nivolumab were included in this subanalysis. The correlation between prior TKI (sunitinib vs. pazopanib) and overall response rate (ORR), disease control rate, progression-free survival and overall survival were investigated. Additionally, the impact of TKI choice according to the International Metastatic RCC Database Consortium prognostic score was examined.Results: There was no significant difference between sunitinib and pazopanib groups in terms of mPFS, mOS, overall response rate and disease control rate. Moreover, no difference between sunitinib and pazopanib was found according to the International Metastatic RCC Database Consortium prognostic score.Conclusion: There is no conclusive evidence favoring pazopanib or sunitinib treatment before initiating nivolumab therapy in metastatic renal cell carcinoma patients.Article highlightsIntroductionTKI monotherapy is still an option for mRCC patientsDespite the success of immune-checkpoint inhibitors, TKI monotherapy remains an option for selected mRCC patients, particularly those with favorable-risk IMDC status or those unsuitable for immunotherapy.In vitro studies have indicated that pazopanib exhibits stronger immunomodulatory activity compared with sunitinib.In clinical practice there are no established criteria for selecting the first-line TKI and the optimal treatment sequence remains uncertain.Material & methodsThis study included patients with mRCC who had progressed after prior treatment with sunitinib or pazopanib and received 2nd or further line nivolumab in a real-world setting.This subanalysis of the Meet-URO 15 study aims to investigate survival (OS, PFS) and response outcomes (ORR, DCR).ResultsThere was no significant difference between previous sunitinib or pazopanib in terms of mPFS, mOS, ORR and DCR.No difference between previous sunitinib and pazopanib was found according to the IMDC prognostic score.There is no conclusive evidence favoring pazopanib or sunitinib treatment before initiating nivolumab therapy in mRCC patients.DiscussionFuture challengesUnderstanding the interactions between immunotherapy, the immune system, and specific types of TKIs remains a relevant topic in both clinical trials and clinical practice.More evidence is needed to better understand the differences among currently available immuno-combinations.Further studies are necessary to gain a better understanding of the optimal treatment selection and sequence.