Pembrolizumab in advanced renal cell carcinoma: a meta-analysis providing level 1a evidence

彭布罗利珠单抗 医学 舒尼替尼 伦瓦提尼 内科学 肿瘤科 肾细胞癌 阿西替尼 无容量 免疫疗法 癌症 甲状腺癌
作者
Umberto Capitanio,Giuseppe Fallara,Daniele Raggi,Luigi Nocera,Alessandro Larcher,Federico Belladelli,Isaline Rowe,Alberto Briganti,Andrea Salonia,Pierre I. Karakiewicz,Francesco Montorsi,Alberto Martini,Andrea Necchi
出处
期刊:Current Problems in Cancer [Elsevier BV]
卷期号:46 (4): 100875-100875 被引量:2
标识
DOI:10.1016/j.currproblcancer.2022.100875
摘要

The recent introduction of immunotherapy in the first line setting of advanced renal cell carcinoma (aRCC) has dramatically improved patients’ prognosis. The aim of the current meta-analysis was to provide level 1a evidence supporting the use of pembrolizumab plus tyrosine kinase inhibitors (TKI) as first-line treatment for advanced RCC. All published randomized prospective trials including patients with advanced RCC treated with pembrolizumab in combination with TKIs vs Sunitinib were included in this meta-analysis. An algorithm was used to reconstruct survival data from the published Kaplan-Meier curves of overall survival (OS), progression free survival (PFS) and duration of response (DoR) from the included trials. Restricted mean survival time (RMST) with 95% confidence interval (CI) for comparison among the different regimens was calculated. Main outcomes were differences in RMST for OS, PFS and DoR for pembrolizumab plus TKIs vs sunitinib arm. Reconstructed survival data from 1,573 patients were retrieved from 2 trials (KEYNOTE-581 and KEYNOTE-426) comparing pembrolizumab plus TKI (lenvatinib or axitinib, respectively) to sunitinib. Patients who received pembrolizumab-lenvatinib or pembrolizumab-axinitinib had better OS (24-month Δ RMST of 1.79 months [95% CI: 0.12-2.50; P < 0.001]), PFS (24-month Δ RMST of 3.83 months [95% CI: 2.93-4.74; P < 0.001]) and DoR (24-month Δ RMST of 2.32 months [95% CI: 0.97-3.67; P < 0.001]) relative to sunitinib. Pembrolizumab-lenvatinib combination gave a marginal benefit in terms of OS, PFS and DoR relative to pembrolizumab-axitinib group. By relying on individual survival data, we provided a level-1a evidence supporting the use of pembrolizumab plus TKI for first-line aRCC treatment.
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