Real-world treatment patterns and outcomes in metastatic clear cell renal cell carcinoma following immune checkpoint inhibitor progression (2018-2023)

INTRODUCTION: Immune checkpoint inhibitors (ICI) have become standard of care for renal cell carcinoma (RCC) in the adjuvant, first-line and pre-treated settings. However, treatment patterns and outcomes of patients with RCC that progresses following ICI treatment are not well characterized. METHODS: A retrospective review of electronic health records from a US community oncology network included patients with metastatic clear cell RCC (mccRCC) that progressed after an initial ICI-containing regimen and received subsequent systemic therapy (index) between 01/01/2018 and 01/31/2023. Patient characteristics and treatment patterns were described. Real-world progression-free survival (rwPFS) and overall survival (OS) were analyzed using Kaplan-Meier method by line of therapy (LOT) of the first ICI-containing regimen and index regimen class. RESULTS: Overall, 299 patients were included (median [IQR] age 68 [60-75] years, 73% male, 85% white, 87% intermediate or poor IMDC risk, median follow-up 11.3 months) with the first ICI-containing regimen initiated in the adjuvant (n = 5, 2%), first-line (n = 203, 68%) or second-line (n = 91, 30%) settings. Vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) monotherapy was the most common index (post-IO) regimen class (62% any VEGFR-TKI, 46% cabozantinib). Median (95% CI) rwPFS and OS were 6.0 (5.4, 6.8) and 14.3 (12.1, 16.4) months, respectively. No differences were observed in rwPFS and OS by LOT of the first ICI-containing regimen (p = 0.763, p = 0.885, respectively) or index regimen class (p = 0.721, p = 0.747, respectively). CONCLUSION: In real-world patients with mccRCC that progressed to the post-ICI setting, VEGFR-TKI monotherapies were the most common post-ICI regimens and differences in clinical outcomes were not observed by LOT of the first ICI-containing regimen or index regimen class. There is high unmet need for novel therapies in the post-ICI setting.