Abstract 5095: Characteristics of patients with advanced renal cell carcinoma (aRCC) who received first-line (1L) nivolumab plus cabozantinib (NIVO+CABO), pembrolizumab plus lenvatinib (PEM+LEN), or nivolumab (NIVO) monotherapy in the real-world (RW) setting
Authors: Zarrabi Kevin K. , Miron Benjamin , Yin Xin , Rosenblatt Lisa , Guttenplan Sarah B. , John William , Miller Taavy A. , Asgarisabet Parisa , Pathak Prathamesh , Ahlquist Monica , Gash Yul Brian , Geynisman Daniel M. 
Published: March 2024

Abstract
Background: Recent advances in immunotherapy have introduced new treatment modalities for aRCC. In absence of guideline recommendations, it is unclear what factors drive providers in selecting 1L treatments for aRCC. To address this gap, we described the baseline demographic and clinical characteristics of patients with aRCC who received 1L NIVO+CABO, PEM+LEN, or NIVO monotherapy in the RW setting.
Methods: In this retrospective cohort study, treating oncologists from a US nationally representative network abstracted electronic health record data from patients with aRCC who initiated 1L NIVO+CABO or NIVO monotherapy (off-label in the US) between 2/1/2021 and 6/12/2023, or PEM+LEN between 9/1/2021 and 6/12/2023. Patient demographic and clinical characteristics were summarized descriptively.
Results: Compared with patients who received NIVO+CABO (n = 200) or PEM+LEN (n = 100), patients who received NIVO (n = 147) were relatively older at 1L initiation (Table). Sex, race, and region of residence were comparable across cohorts. Patients who received NIVO were more likely to have an ECOG PS score of ≥ 2 (59.2%) compared with NIVO+CABO (14.5%) or PEM+LEN (20%) cohorts. The distribution of MSKCC or IMDC risk scores at 1L initiation was comparable across cohorts . Grade 3 or 4 tumors were reported among 56.5%, 41.0%, and 43.5% of those who received NIVO+CABO, PEM+LEN, and NIVO, respectively.
Conclusions: This study suggests that 1L treatment for aRCC using IO monotherapy may be more likely to be considered than IO-TKI therapy for older patients and those with poorer ECOG PS, possibly reflecting perceived tolerability of TKI combinations in these patient populations. Further research is needed to understand the impact of these 1L treatment selection patterns on outcomes.
Table: Key patient characteristics at 1L initiation. PEM+LEN NIVO+CABO NIVO n = 100 n = 200 n = 147 Mean age, year (standard deviation) 64.4 (7.9) 66.3 (7.4) 74.1 (9.6) Male, n (%) 93 (63.3) 122 (61.0) 93 (63.3) Race, n (%) White 61 (61.0) 127 (63.5) 91 (61.9) Non-white/unknown 39 (39.0) 73 (36.5) 56 (38.1) Region of residence, n (%) Northeast 23 (23.0) 44 (22.0) 37 (25.2) Midwest 22 (22.0) 53 (26.5) 27 (18.4) South 20 (20.0) 34 (17.0) 33 (22.4) West 35 (35.0) 69 (34.5) 50 (34.0) MSKCC or IMDC risk score, n (%) Favorable 13 (13.0) 28 (14.0) 22 (15.0) Intermediate 57 (57.0) 100 (50.0) 74 (50.3) Poor 28 (28.0) 68 (34.0) 41 (27.9) ECOG-PS, n (%) 0 or 1 80 (80.0) 171 (85.5) 60 (40.8) ≥2 20 (20.0) 29 (14.5) 87 (59.2) Grade of tumor differentiation, n (%) Grade 1 3 (3.0) 10 (5.0) 16 (10.9) Grade 2 56 (56.0) 77 (38.5) 67 (45.6) Grade 3 36 (36.0) 98 (49.0) 55 (37.4) Grade 4 5 (5.0) 15 (7.5) 9 (6.1)
Citation Format: Kevin K. Zarrabi, Benjamin Miron, Xin Yin, Lisa Rosenblatt, Sarah B. Guttenplan, William John, Taavy A. Miller, Parisa Asgarisabet, Prathamesh Pathak, Monica Ahlquist, Yul Brian Gash, Daniel M. Geynisman. Characteristics of patients with advanced renal cell carcinoma (aRCC) who received first-line (1L) nivolumab plus cabozantinib (NIVO+CABO), pembrolizumab plus lenvatinib (PEM+LEN), or nivolumab (NIVO) monotherapy in the real-world (RW) setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5095.