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コムラ カズマサ
Kazumasa Komura
小村 和正 所属 川崎医科大学 医学部 臨床医学 泌尿器科学 職種 教授 |
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| 論文種別 | 原著 |
| 言語種別 | 英語 |
| 査読の有無 | 査読あり |
| 表題 | First-line therapy for metastatic renal cell carcinoma: A propensity score-matched comparison of efficacy and safety. |
| 掲載誌名 | 正式名：Urologic oncology 略 称：Urol Oncol ISSNコード：18732496/10781439 |
| 掲載区分 | 国外 |
| 巻・号・頁 | 42(11),pp.374.e21-374.e29 |
| 著者・共著者 | Takafumi Yanagisawa, Keiichiro Mori, Tatsushi Kawada, Satoshi Katayama, Taizo Uchimoto, Takuya Tsujino, Kazuki Nishimura, Takahiro Adachi, Shingo Toyoda, Takuhisa Nukaya, Wataru Fukuokaya, Fumihiko Urabe, Masaya Murakami, Tomoaki Yamanoi, Kensuke Bekku, Kazumasa Komura, Kiyoshi Takahara, Takeshi Hashimoto, Kazutoshi Fujita, Haruhito Azuma, Yoshio Ohno, Ryoichi Shiroki, Hirotsugu Uemura, Motoo Araki, Takahiro Kimura, |
| 発行年月 | 2024/11 |
| 概要 | PURPOSE:Immune checkpoint inhibitor (ICI)-based combination therapy is a standard systemic treatment for metastatic renal cell carcinoma (mRCC). Although differential pharmacologic action between ICI+ICI and ICI+tyrosine kinase inhibitor (TKI) combinations may affect outcomes, comparative studies using real-world data are few.METHODS:We retrospectively analyzed the records of 447 mRCC patients treated with 1st-line ICI-based combinations at multiple institutions between January 2018 and August 2023, and selected 320 patients diagnosed with clear cell RCC (ccRCC) for further study. Cohorts were matched using one-to-one propensity scores based on IMDC risk classification. Overall survival (OS), progression-free survival (PFS), objective response rates (ORRs), and treatment-related adverse events (TrAE) were compared.RESULTS:The matching process yielded 228 metastatic ccRCC patients treated with ICI+ICI (n = 114) or ICI+TKI (n = 114). Median OS was 53 months (95%CI: 33-NA) in patients treated with ICI+ICI and was not reached (95%CI: 43-NA) with ICI+TKI (P = 0.24). Median PFS was significantly shorter for ICI+ICI (13 months, 95%CI: 7-25) than for ICI+TKI (25 months, 95%CI: 13-NA) (P = 0.047). There were no differences in second-line PFS for sequential therapy after 1st-line combinations of ICI+ICI or ICI+TKI (6 vs. 8 months, P = 0.6). There were no differences in ORR between the 2 groups (ICI+ICI: 51% vs. ICI+TKI: 55%, P = 0.8); the progressive disease (PD) rate was significantly higher in patients treated with the ICI+ICI combination (24% vs. 11%, P = 0.029). The rate of any grade TrAE was significantly higher in patients treated with ICI+TKI (71% vs. 85%, P = 0.016), but we found no differences in severe TrAE between the 2 groups (39% vs. 36%, P = 0.8).CONCLUSIONS:In a matched cohort of real-world data, we confirmed comparable OS benefits between ICI+ICI and ICI+TKI combinations. However, differential clinical behaviors in terms of PFS, PD rates, and TrAE between ICI- |
| DOI | 10.1016/j.urolonc.2024.06.013 |
| PMID | 39085019 |