Dual therapy confers no survival gains in advanced renal cell carcinoma

Dual therapy with immune checkpoint inhibitors (ICIs) does not appear to prolong overall survival (OS) as compared with sunitinib alone for advanced renal cell carcinoma (aRCC) patients with favourable risk, according to the results of a meta-analysis.

Researchers searched multiple online databases for phase II or III randomized controlled trials evaluating first-line, palliative-intent dual therapy in aRCC patients of favourable risk. They identified seven trials involving a total of 1,214 patients for inclusion in the meta-analysis.

Pooled data obtained using inverse-variance with random-effects model revealed no significant difference in OS between the dual therapy and the sunitinib monotherapy group (hazard ratio [HR], 0.96, 95 percent confidence interval [CI], 0.73–1.26; p=0.79).

Results were consistent in a sensitivity analysis that excluded ICI–ICI combination regimens, with no OS benefit observed (HR, 0.99, 95 percent CI, 0.69–1.43; p=0.96).

Likewise, use of dual therapy in the favourable-risk group had no significant effect on progression-free survival (HR, 0.75, 95 percent CI, 0.50–1.13; p=0.17). However, it showed some benefit when ICI-ICI regimen was excluded from the analysis (HR, 0.63, 95 percent CI, 0.50–0.79; p<0.001).

A longer follow-up is needed to definitively detect potential OS benefit, if any, according to the researchers. Alternative management options must be carefully considered and discussed prior to initiating dual therapy among aRCC patients with a favourable risk.