التفاصيل البيبلوغرافية
| العنوان: |
Meta-analysis of perioperative immunotherapy in renal cell carcinoma: Available, but the jury is still out. |
| المؤلفون: |
Esteban-Villarrubia, Jorge1 (AUTHOR) jorge.e.villarrubia@gmail.com, Romero Ferreiro, Carmen2,3 (AUTHOR), Carril-Ajuria, Lucía4 (AUTHOR), Carretero-González, Alberto5 (AUTHOR), Iacovelli, Roberto6 (AUTHOR), Albiges, Laurence7 (AUTHOR), Castellano, Daniel1 (AUTHOR), de Velasco, Guillermo1 (AUTHOR) |
| المصدر: |
Urologic Oncology. Sep2023, Vol. 41 Issue 9, p391.e13-391.e21. 1p. |
| مصطلحات موضوعية: |
*CLINICAL trials, *IMMUNE checkpoint inhibitors, *IMMUNOTHERAPY, *ADVERSE health care events, *RENAL cancer |
| مستخلص: |
• Our meta-analysis suggests no overall or disease-free survival benefit from adjuvant immunotherapy in renal cancer. • Included trials have heterogeneous design and included populations that may explain the discordant results. • Sarcomatoid differentiation, PD-L1 positive tumors and females may have more benefit from adjuvant immunotherapy. • Concerns of additive toxicity arise as adverse events and treatment-related deaths are more frequent in immunotherapy population. • Ongoing randomized clinical trials, longer follow-up data and individual participant data meta-analyses will clarify the role of adjuvant immunotherapy in renal cancer. While surgical management of renal cell carcinoma (RCC) is curative for many patients, others may relapse and could benefit from adjuvant treatments. Immune checkpoint inhibitors (ICI) have been proposed as a potential adjuvant therapy for improving survival in these patients, but the benefit/risk ratio of ICI in the perioperative setting remains unclear. A systematic review and a meta-analysis of phase III trials of perioperative ICI (anti PD1/PD-L1 alone or in combination with anti-CTLA4 agents) in RCC was conducted. The analysis included results from 4 phase III trials, comprising 3,407 patients. ICI did not show a significant increase in disease-free survival (Hazard Ratio [HR] 0.85; 95% confidence interval [CI] 0.69–1.04; p : 0.11) or overall survival [OS] (HR 0.73; 95% CI 0.40–1.34; p : 0.31). High-grade adverse events were more frequent in the immunotherapy arm (OR 2.65; 95% CI 1.53-4.59; p : <0.001), and high-grade treatment-related adverse events were 8 times more frequent in the experimental arm (OR: 8.07; 95% CI: 3.14–20.75; p : <0.001). Subgroup analyses showed statistically significant differences favoring the experimental arm in females (HR: 0.71; 95 CI 0.55–0.92; p : 0.009), in sarcomatoid differentiation (HR: 0.60 95% CI 0.41–0.89; p : 0.01), and PD-L1 positive tumors (HR HR: 0.74; 95% CI 0.61–0.90; p : 0.003). No significant effect was found in patients according to age, type of nephrectomy (radical vs. partial), and stage (M1 without evidence of disease vs. M0 patients). Our comprehensive meta-analysis generally suggests that immunotherapy does not confer a survival advantage in the perioperative setting for RCC, with the exception of one positive study. While the overall results are not statistically significant, individual patient factors and other variables may play a role in determining who benefits from immunotherapy. Therefore, despite the mixed findings, immunotherapy may still be a viable treatment option for certain patients, and further studies are needed to determine which patient subgroups would be most likely to benefit. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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