Thromboembolism linked to shorter survival in metastatic renal cell carcinoma
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Thromboembolism incidence appeared high among patients who received immunotherapy-based combinations for metastatic renal cell carcinoma, according to retrospective study results.
Rates appeared similar between those who received two immune checkpoint inhibitors (IO/IO) and those who received an immune checkpoint inhibitor in combination with a VEGF receptor tyrosine kinase inhibitor (IO/TKI), results presented at International Kidney Cancer Symposium: North America showed.
In addition, patients who developed thromboembolism achieved shorter survival.
Most patients with treatment-naive metastatic renal cell carcinoma receive either an IO/IO combination or an IO/TKI combination, according to study background. Thromboembolism incidence in these settings have not been clearly established, and additional insights in this area could help guide treatment decision-making.
James Schuster, MD, fellow at Cleveland Clinic Taussig Cancer Institute, and colleagues assessed thromboembolic events — including venous and arterial thromboembolism — among patients with metastatic renal cell carcinoma who received an IO-based combination between January 2015 and April 2021 at Cleveland Clinic.
Researchers performed competing-risk regression to identify factors associated with thromboembolism incidence after therapy. They classified all-cause mortality as a competing event.
The analysis included 128 patients (median age, 62 years; range, 14-89; 78% male; 94% white) treated with an IO/IO combination and 92 patients (median age, 66 years; range, 31-87; 75% male; 97% white) treated with an IO/TKI combination.
A comparable percentage of patients in the IO/IO and IO/TKI groups had clear cell histology (77% vs. 83%), poor-risk disease (19% vs. 16%) and Khorana score of 2 or higher (48% vs. 46%).
A higher percentage of those treated with IO/TKI than IO/IO had developed thromboembolism prior to starting an IO-based regimen (19% vs. 10%). Karnofsky performance status (median, 90 in each group) and receipt of anticoagulation prior to IO therapy (12% vs. 13%) appeared comparable between the IO/IO and IO/TKI groups.
After median follow-up of 23 months, 10.9% of all patients in the analysis developed thromboembolism.
Researchers reported cumulative thromboembolism rates after therapy of 13% in the IO/IO group (12% VTE and 1% arterial thromboembolism) and 9% in the IO/TKI group (all VTE), with 1-year thromboembolism rates of 9% in the IO/IO group and 8% in the IO/TKI group.
Results showed no statistically significant difference in incidence between the IO/TKI and IO/IO groups (HR = 0.74; 95% CI, 0.31-1.73).
Thromboembolism incidence did not vary based on age, sex, race, prior history of thromboembolism, International Metastatic Renal Cell Carcinoma Database Consortium risk group classification or Khorana score.
Schuster and colleagues reported shorter OS among patients who developed thromboembolism (HR = 2.35; 95% CI, 1.36-4.07).
“Further investigations comparing these thromboembolism rates vs. those [among] patients receiving IO and TKI monotherapies is ongoing,” Schuster and colleagues wrote.
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Schuster J, et al. Abstract 43. Presented at: International Kidney Cancer Symposium: North America; Nov. 4-5, 2022; Austin, Texas.
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