(UroToday.com) The 2022 ASCO annual meeting featured a session on kidney and bladder cancer, including a presentation by Dr. Sara Rebuzzi discussing a sub-analysis of the Meet-URO 15 study assessing the prognostic role of nephrectomy in patients with metastatic renal cell carcinoma (mRCC) treated with immunotherapy according to the novel prognostic Meet-URO score. Most mRCC patients with favorable and intermediate prognosis, according to the IMDC classification, are offered a nephrectomy. However, in the immunotherapy era, the role of nephrectomy is still unclear. In the Meet-URO 15 study Dr. Rebuzzi and colleagues reported the higher prognostic accuracy of the Meet-URO score compared to the IMDC score, by the addition of the neutrophil-to-lymphocyte ratio and the presence of bone metastases to the IMDC score, identifying five categories with progressively worse prognosis. For this reason, theay aimed to explore the prognostic impact of a previous nephrectomy on mRCC patients receiving immunotherapy and according to the Meet-URO score groups.
The Meet-URO 15 study was a multicenter retrospective analysis on 571 pretreated mRCC patients receiving nivolumab. Univariable analysis of the correlation between previous nephrectomy and overall survival (OS) and multivariate analysis adjusted for IMDC score, therapy line, neutrophil-to-lymphocyte ratio and metastatic sites were performed. The interaction of previous nephrectomy with the Meet-URO prognostic groups was then evaluated.
Data on Meet-URO score were available in 556 patients (97%) and 490 patients had a previous nephrectomy (88%). The patient characteristics are summarized as follows:
A reduced risk of death (HR = 0.44; 95% CI: 0.32-0.60; p < 0.001) and higher median OS and OS rate were observed in patients with previous nephrectomy than without (median OS: 36 vs 13 months; 1-year-OS 72% vs 52% and 2-year-OS 57% vs 24%, respectively):
The reduced risk of death for patients who underwent the previous nephrectomy was also confirmed at multivariate analysis (HR 0.69; 95% CI: 0.49-0.97; p = 0.032). The percentage of patients receiving previous nephrectomy progressively reduced through the five Meet-URO prognostic groups:
- Group 1: 98%
- Group 2: 95%
- Group 3: 84%
- Group 4: 79%
- Group 5: 59%
No significant interaction was observed between the previous nephrectomy and Meet-URO score when all the five groups were considered (p = 0.17). A significant interaction was observed when the Meet-URO groups 1,2 and 3 were taken together (HR 0.40; 95% CI: 0.25-0.63; p < 0.001), highlighting the significant protective role of the previous nephrectomy on OS for these three groups. For the Meet-URO groups 4 and 5, the interaction was indeed not significant (HR 0.81; 95% CI: 0.51-1.30; p = 0.39):
Dr. Rebuzzi concluded her presentation by discussing a sub-analysis of the Meet-URO 15 study assessing the prognostic role of nephrectomy in patients with mRCC treated with immunotherapy according to the Meet-URO score with the following take-home messages:
- The previous nephrectomy has a favorable prognostic impact on pretreated mRCC patients receiving immunotherapy
- This benefit may be limited to mRCC patients with more favorable diseases belonging to Meet-URO prognostic groups 1, 2 and 3
- Further analysis of the type of previous nephrectomy (i.e., radical vs cytoreductive) is ongoing, and confirmatory prospective evaluations are warranted
Presented by: Sara E. Rebuzzi, MD, Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova
Co-Authors: Alessio Signori, Giuseppe Luigi L. Banna, Sebastiano Buti, Pasquale Rescigno, Maria Gemelli, Stefano Panni, Francesco Massari, Mariella Sorarù, Matteo Santoni, Alessio Cortellini, Veronica Prati, Hector Josè Soto Parra, Francesco Atzori, Marilena Di Napoli, Orazio Caffo, Marco Messina, Franco Morelli, Giuseppe Prati, Giuseppe Fornarini
Affiliations: Medical Oncology Unit, Ospedale San Paolo, Savona, Italy, Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy, Medical Oncology Unit, University Hospital of Parma, Parma, Italy, Department of Medicine and Surgery, University of Parma, Parma, Italy, Medical Oncology Unit, IRCCS MultiMedica, Milan, Italy, Medical Oncology Unit, ASST-Istituti Ospitalieri Cremona Hospital, Cremona, Italy, Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, Medical Oncology, Camposampiero Hospital, Camposampiero, Italy, Medical Oncology Unit, Macerata General Hospital, Macerata, Italy, Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, London, United Kingdom; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, London, United Kingdom, Department of Medical Oncology, Ospedale S. Lazzaro Azienda Sanitaria Locale CN2, Alba-Bra, Cuneo, Italy, Department of Oncology, Medical Oncology, University Hospital Policlinico-San Marco, Catania, Italy, Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy, Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy, Presidio Ospedaliero Santa Chiara di Trento, APSS Trento, Trento, Italy, Medical Oncology Unit, A.R.N.A.S. Civico, Palermo, Italy, Medical Oncology Department, IRCCS Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy, Department of Oncology and Advanced Technologies, Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy, Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, IL, Fri, June 3 – Mon, June 7, 2022.