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Introduction <p>Access to first-line immune checkpoint inhibitor (ICI) combinations in metastatic renal cell carcinoma (mRCC) remains limited in many low- and middle-income countries. Consequently, tyrosine kinase inhibitors (TKIs) are still widely used. This study investigates the impact of first-line sunitinib versus pazopanib on survival outcomes with second-line nivolumab.</p> Methods <p>We conducted a retrospective analysis of 245 patients with mRCC from the Turkish Oncology Group Kidney Cancer Consortium Database. Patients received first-line sunitinib or pazopanib, followed by second-line nivolumab. Primary endpoints were time to treatment failure (TTF) and overall survival (OS). Subgroup analyses were performed based on IMDC risk classification and presence of sarcomatoid features.</p> Results <p>A total of 245 patients who were treated with sunitinib or pazopanib monotherapy as first-line treatment followed by nivolumab as second-line treatment were included in this study. Median TTF following nivolumab initiation was similar between prior sunitinib and pazopanib groups (7.79 vs 7.72&#xa0;months; <i>p</i> = 0.892). Median OS-2 was 27.21&#xa0;months with prior sunitinib and 18.92&#xa0;months with prior pazopanib (<i>p</i> = 0.496). In patients with sarcomatoid features (<i>n</i> = 20), those pretreated with pazopanib demonstrated numerically longer OS-2 compared to sunitinib (<i>p</i> = 0.023), although the small sample size limits definitive conclusions.</p> Conclusion <p>No significant differences in survival outcomes were observed between first-line sunitinib and pazopanib before nivolumab in mRCC. In the small subgroup with sarcomatoid features, pazopanib pre-treatment was associated with a numerically longer survival. These findings warrant cautious interpretation and further prospective validation, especially in resource-constrained settings.</p>

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Impact of first-line tyrosine kinase inhibitor selection on survival outcomes with second-line nivolumab in metastatic renal cell carcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月25日

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  • Omer Faruk Kuzu,
  • Hatice Bolek,
  • Elif Sertesen Camoz,
  • Hilal Karakas,
  • Serhat Sekmek,
  • Saadet Sim,
  • Selver Isık,
  • Murat Günaltılı,
  • Aysun Fatma Akkus,
  • Deniz Tural,
  • Cagatay Arslan,
  • Sema Sezin Goksu,
  • Ozlem Nuray Sever,
  • Cengiz Karacin,
  • Mehmet Ali Nahit Sendur,
  • Nuri Karadurmus,
  • Emre Yekedüz,
  • Yüksel Ürün

摘要

Introduction

Access to first-line immune checkpoint inhibitor (ICI) combinations in metastatic renal cell carcinoma (mRCC) remains limited in many low- and middle-income countries. Consequently, tyrosine kinase inhibitors (TKIs) are still widely used. This study investigates the impact of first-line sunitinib versus pazopanib on survival outcomes with second-line nivolumab.

Methods

We conducted a retrospective analysis of 245 patients with mRCC from the Turkish Oncology Group Kidney Cancer Consortium Database. Patients received first-line sunitinib or pazopanib, followed by second-line nivolumab. Primary endpoints were time to treatment failure (TTF) and overall survival (OS). Subgroup analyses were performed based on IMDC risk classification and presence of sarcomatoid features.

Results

A total of 245 patients who were treated with sunitinib or pazopanib monotherapy as first-line treatment followed by nivolumab as second-line treatment were included in this study. Median TTF following nivolumab initiation was similar between prior sunitinib and pazopanib groups (7.79 vs 7.72 months; p = 0.892). Median OS-2 was 27.21 months with prior sunitinib and 18.92 months with prior pazopanib (p = 0.496). In patients with sarcomatoid features (n = 20), those pretreated with pazopanib demonstrated numerically longer OS-2 compared to sunitinib (p = 0.023), although the small sample size limits definitive conclusions.

Conclusion

No significant differences in survival outcomes were observed between first-line sunitinib and pazopanib before nivolumab in mRCC. In the small subgroup with sarcomatoid features, pazopanib pre-treatment was associated with a numerically longer survival. These findings warrant cautious interpretation and further prospective validation, especially in resource-constrained settings.