Comparable Findings in White and Black Populations for ICI Use in Metastatic RCC

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Practices should not differentiate treatment options based on race for patients with metastatic renal cell carcinoma, according to Jasmeet Kaur, MD.

“There is a potential benefit of ICI in both Black and White populations, so we should not differentiate the treatment options based on race,” according to Jasmeet Kaur, MD.

“There is a potential benefit of ICI in both Black and White populations, so we should not differentiate the treatment options based on race,” according to Jasmeet Kaur, MD.

Using immune checkpoint inhibitor (ICI) combinations or ICIs in combination with tyrosine kinase inhibitors (TKIs) did not appear to produce significant differences in treatment outcomes between patients who are White and Black with metastatic renal cell carcinoma (RCC), according to findings from a real-world study conducted by Fox Chase Cancer Center of Temple Health.1

Among White patients, the median real-world progression-free survival (PFS) was 9.3 months for those who received an ICI plus a TKI vs 7.0 months for those who received sunitinib (Sutent; P <.001). Additionally, the median PFS in patients who were White was 5.7 months for those who received an ICI plus an ICI (P = .1) vs 7.0 months for those receiving sunitinib (P = .1) and 7.2 months vs 7.0 months for those who were treated with an ICI in combination with another ICI or a TKI vs sunitinib (P = .002).

The real-world median PFS for patients who were Black was 7.8 months among those who received an ICI plus a TKI vs 5.4 months for those who were treated with sunitinib (P = .6). Additionally, the median PFS for patients who were Black was 4.7 months in those who received an ICI combination vs 5.4 months for sunitinib (P = .5) and 5.6 months in those who received an ICI plus another ICI or a TKI vs 5.4 months for sunitinib (P = .4).

Investigators reported a real-world PFS HR of 0.87 (P = .04) for patients who were White who received ICI/ICI or ICI/TKI treatment compared with sunitinib in the first 10 months, and the HR was 0.664 (P <.01) after 10 months. Among patients who were Black, the HR for PFS among those who received ICI/ICI or ICI/TKI treatment vs sunitinib was 0.64 (P = .07) in the first 10 months and 0.51 (P = .07) after 10 months.

Overall, there was no differential treatment effect based on race with ICI/ICI or ICI/TKI therapy vs sunitinib within the first 10 months (HR, 1.14; P = .11) or after the first 10 months (HR, 1.06; P = .75).

“There is a potential benefit of ICI in both Black and White populations, so we should not differentiate the treatment options based on race,” lead study author Jasmeet Kaur, MD, a second-year fellow in the Department of Hematology/Oncology at Fox Chase, said in a press release on these findings.2

In this retrospective cohort study, investigators collected data from the Nationwide US Flatiron Health EHR-derived database from 2011 to 2022. Data were gathered on the available races of patients diagnosed with metastatic RCC who received frontline therapy with an ICI plus another ICI, an ICI plus a TKI, or sunitinib.

The study’s primary objective was to compare real-world PFS in patients who were Black and White with the aforementioned treatment types. Real-world PFS was calculated for each patient group with Kaplan-Meier curves, log-rank tests, and Cox proportional models.

The study included a total of 2592 patients, 2379 and 213 of whom were White and Black, respectively. Between either group, most were treated with ICI/ICI or ICI/TKI therapy (56.0% vs 56.1%; P = .931), male (71.4% vs 62.9%; P = .01), and underwent nephrectomy (66.9% vs 55.0%; P = .002). With respect to International Metastatic RCC Database Consortium risk groups, most patients in each group had intermediate-risk disease (30.2% vs 34.7%) followed by poor- or intermediate-risk disease (29.3% vs 28.6%) and poor-risk disease (18.0% vs 23.5%).

Investigators noted that the small number of patients who were Black included in the study may have affected their outcomes. These data were presented in a poster session at the 2024 Genitourinary Cancers Symposium.

References

  1. Kaur J, Hasler JS, Handorf EA, et al. Comparison of outcomes between patients of African and European descent with metastatic renal cell carcinoma receiving immune checkpoint inhibitors. J Clin Oncol. 2024;42(suppl 4):369. doi:10.1200/JCO.2024.42.4_suppl.369
  2. New Fox Chase study finds immunotherapy effective for both Black and White patients with metastatic renal cell carcinoma. News release. Fox Chase Cancer Center. January 26, 2024. Accessed February 6, 2024. http://tinyurl.com/5yhy8e22
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