轉移性腎細胞癌的免疫治療成效分析-臺北榮總的經驗
余秉軒1、魏子鈞1,2,3、林子平1,2,3、鍾孝仁1,2,3、張延驊1,2,3、黃志賢1,2,3
台北榮民總醫院泌尿部1
國立陽明大學醫學系泌尿學科2
書田泌尿科學研究中心3
The Evaluation of Immunotherapy Response for Patients with Metastasis Renal Cell Carcinoma in Taipei Veterans General Hospital
Ping-Hsuan Yu1, Tzu-Chun Wei1,2,3, Tzu-Ping Lin1,2,3, Hsiao-Jen Chung1,2,3, Yen-Hwa Chang1,2,3, William J.S. Huang1,2,3
1 Department of Urology, Taipei Veterans General Hospital
2 Department of Urology, School of Medicine,
National Yang-Ming University Taipei, Taiwan
3Shu-Tien Urological Science Research Center, Taipei, Taiwan
Purpose:
Compared to traditional targeted therapy, immunotherapy has shown significant efficacy in patients with metastatic renal cell carcinoma (mRCC). With fewer severe adverse events incidence, some patients can benefit from long duration of disease control. In this study, we aim to retrospectively evaluate the treatment response and progression-free survival in patients with mRCC in a single institute.
Materials and Methods:
Data of patients with mRCC treated with immunotherapy including Pembrolizumab only, Pembrolizumab plus Axitinib, Nivolumab only, Nivolumab plus ipilimumab were reviewed from November 2016 to September 2018. The cell subtype, clinical stage, laboratory data, treatment duration and response were recorded. Based on the Memorial Sloan-Kettering Cancer Center (MSKCC/Motzer) and the International Metastatic Renal Cell Carcinoma Database Consortium model (IMDC/Heng) criteria, risk factors were stratified. Demographic data and predictive factors were evaluated and compared with Mann-Whitney U and Fisher’s exact tests.
Results:
Total 13 patients with mRCC treated with immunotherapy were recruited, including 6 with Pembrolizumab + Axitinib (46%, first-line), 3 with Pembrolizumab only (23%, first-line), 2 with Nivolumab only (15%, second-line), and 2 with Nivolumab + Ipilimumab (15%, first-line). Clear cell type accounted for 85%. Three patients in the Pembrolizumab + Axitinib group, and one in the Pembrolizumab only group, has had complete remission (CR) with the longest disease control duration for 20 months. One patient treated with Pembrolizumab only has had partial remission (PR). The objective response rate (ORR) was 38.4%, with stable disease (SD) and progressive disease (PD) represented 23.2% and 38.4%, respectively. Between responders (complete remission, partial remission, and stable disease) and non-responders (progression disease), higher MSKCC and IMDC score were significantly correlated with shorter progression–free survival.
Conclusions:
In this study, the ORR was 38.4%, with CR 30.7%. Patients who responded to immunotherapy had lower MSKCC and IMDC score.