The Clinical Significance of Routine Risk Categorization in Metastatic Renal Cell Carcinoma and its Impact on Treatment Decision-Making: A Systematic Review

Abstract

Aim: To analyze responses to first-line metastatic renal cell carcinoma (mRCC) treatment stratified by risk criteria. Patients & methods: Clinical trials and observational studies of patients aged ≥18 years, published January 2005–May 2019, were identified via Ovid from MEDLINE, EMBASE, the Cochrane Central Trials Register and the Cochrane Database of Systematic Reviews. Data extracted included progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). Results: 47/1269 articles met eligibility criteria. Most studies stratified patients by International Metastatic RCC Database Consortium (n = 19) or Memorial Sloan Kettering Cancer Center (n = 21). PFS, OS and ORR varied according to risk group. Conclusion: Pembrolizumab + axitinib, ipilimumab + nivolumab and avelumab + axitinib were most effective across all risk groups. Favorable-risk patients benefit from sunitinib treatment.

Keywords::

• combination treatment
• guidelines
• prognostic
• renal cell carcinoma
• risk group
• sunitinib

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/fon-2020-0500

Author contributions

All authors made substantial contributions to: the conception, design, analysis and interpretation of data; drafting and critical revision of the work for important intellectual content; provided final approval of the manuscript for publication, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Financial & competing interests disclosure

S Bazarbashi has received honoraria from Pfizer for serving on advisory boards, conference sponsorship, and research grants from Pfizer. A Alsharm and J Zekri have served in an advisory role for Pfizer. F Azam has received honoraria from Pfizer for serving on advisory boards and as a speaker. H El Ashry was an employee and shareholder of Pfizer Inc at the time of the study. The systematic literature review to support this report was sponsored by Pfizer. A Chopra of Curo provided editorial, research and writing support for the development of the systematic literature review, which was funded by Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Medical writing support was provided by L Adams of Engage Scientific Solutions, and funded by Pfizer.

Data sharing statement

Upon request, and subject to certain criteria, conditions and exceptions (see https://www.pfizer.com/science/clinical-trials/trial-data-and-results for more information), Pfizer will provide access to individual de-identified participant data from Pfizer-sponsored global interventional clinical studies conducted for medicines, vaccines and medical devices (1) for indications that have been approved in the US and/or EU or (2) in programs that have been terminated (i.e., development for all indications has been discontinued). Pfizer will also consider requests for the protocol, data dictionary and statistical analysis plan. Data may be requested from Pfizer trials 24 months after study completion. The de-identified participant data will be made available to researchers whose proposals meet the research criteria and other conditions, and for which an exception does not apply, via a secure portal. To gain access, data requestors must enter into a data access agreement with Pfizer.

Additional information

Funding

S Bazarbashi has received honoraria from Pfizer for serving on advisory boards, conference sponsorship, and research grants from Pfizer. A Alsharm and J Zekri have served in an advisory role for Pfizer. F Azam has received honoraria from Pfizer for serving on advisory boards and as a speaker. H El Ashry was an employee and shareholder of Pfizer Inc at the time of the study. The systematic literature review to support this report was sponsored by Pfizer. A Chopra of Curo provided editorial, research and writing support for the development of the systematic literature review, which was funded by Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.