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Modeling Spontaneous Metastatic Renal Cell Carcinoma mRCC in Mice Following Nephrectomy
Published on: April 29, 2014
Treatment of metastatic renal cell carcinoma in older patients: A network meta-analysis
Peter Hale1, Andrew W Hahn1, Nityam Rathi1
1Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States.
Introduction:
More than half of patients diagnosed with renal cell carcinoma (RCC) are age 65 or older. However, older patients are often unable to meet eligibility criteria for clinical trial enrollment due to multiple factors, such as comorbidities and polypharmacy, which leads to under-representation of this population in clinical trials. Given this, efficacy data from the registration trials may not apply to older patients. Our objective was to evaluate the efficacy of first-line and salvage-line treatment in older patients, and compare efficacy between older and younger patients with metastatic RCC (mRCC).
Methods:
Pivotal phase three clinical trials for first-line and salvage-line treatments were included if they reported overall survival (OS) or progression-free survival (PFS) results stratified by age (
Results:
In the first-line setting, data suggests that Nivolumab plus Ipilimumab is the most efficacious treatment for older patients (PFS hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.23-1.45, probability best 39.7%). In the salvage-line setting, Cabozantinib is likely the most efficacious therapy for older patients (PFS HR 0.15, 95% CI 0.08-0.28, probability best 77.2%). Evidence suggests that the majority of first-line treatments have worse efficacy in older patients compared to younger patients.
Conclusion:
For older patients, first-line Nivolumab plus Ipilimumab and salvage-line Cabozantinib may offer the best survival outcomes. Most first-line drugs for mRCC have inferior performance in older patients compared to their younger counterparts.
Insights
Older adults with metastatic renal cell carcinoma (mRCC) may benefit most from first-line Nivolumab plus Ipilimumab and salvage-line Cabozantinib. Many first-line treatments show reduced efficacy in older patients compared to younger ones.
Area of Science:
- Oncology
- Geriatric Medicine
- Clinical Pharmacology
Background:
- Over half of renal cell carcinoma (RCC) patients are 65+, but often excluded from clinical trials.
- This under-representation limits the applicability of trial data to older populations.
- Efficacy of treatments for metastatic RCC (mRCC) in older adults requires specific evaluation.
Purpose of the Study:
- To assess the efficacy of first-line and salvage-line treatments in older mRCC patients.
- To compare treatment efficacy between older and younger mRCC patient groups.
Main Methods:
- A meta-analysis of pivotal phase three clinical trials reporting overall survival (OS) or progression-free survival (PFS) stratified by age (≥65 years).
- Bayesian hierarchical log-linear models were used to analyze OS and PFS data, accounting for within- and between-study variances.
Main Results:
- First-line: Nivolumab plus Ipilimumab showed the highest efficacy in older patients (PFS HR 0.55).
- Salvage-line: Cabozantinib appeared most efficacious for older patients (PFS HR 0.15).
- First-line treatments generally demonstrated worse efficacy in older versus younger patients.
Conclusions:
- First-line Nivolumab plus Ipilimumab and salvage-line Cabozantinib may provide optimal survival outcomes for older mRCC patients.
- Most first-line therapies exhibit diminished effectiveness in older individuals compared to their younger counterparts.
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