EURURO Vol. 72 No. 6

Research Letters

uence of Prior Tyrosine Kinase Inhibitor on Survival for

Patients with Metastatic Renal Cell Carcinoma Treated

with Nivolumab or Cabozantinib: Data from a

Literature-based Meta-analysis

Giandomenico Roviello

a , b , * , Daniele Generali b , c

First-line treatment of metastatic renal cell carcinoma still

involves small-molecule tyrosine kinase inhibitors (TKIs)

such as sunitinib and pazopanib, which mainly target the

vascular endothelial growth factor receptor (VEGFR)

[1]

. It

has recently been shown that two agents improve survival

in second-line treatment. In the METEOR trial

[2]

, cabo-

zantinib, a multikinase inhibitor targeting the VEGFR and

other pathways including MET, RET and AXL, and in the

CheckMate 025 study

[3] ,

nivolumab, an immunotherapeu-

tic agent that inhibits the T-cell checkpoint regulator PD-1,

were compared to everolimus and showed a survival

advantage. However the most effective sequence after

first-line TKI treatment is still unknown, so there is a need to

identify factors that predict the response to nivolumab and

cabozantinib. The aimof this letter is to focus on the survival

of patients treated with nivolumab and cabozantinib

according to prior first-line TKI. We used data from

CheckMate 025 and METEOR for a subsequent subgroup

analysis

( Table 1

)

[4,5]

. A pooled analysis according to prior

TKI treatment revealed that survival was significantly

improved to a greater extent after prior treatment with

pazopanib (hazard ratio [HR] 0.62, 95% confidence interval

[CI] 0.47

–

0.82;

= 0.0009) when comparison to sunitinib

(HR 0.76, 95% CI 0.62

–

0.92;

p =

0.005;

Fig. 1 )

Athough a limitation of this analysis is that literature

data were used rather than a meta-analysis of data for

individual patients, so that definitive conclusions need to be

considered carefully, our data show that cabozantinib and

E U R O P E A N U R O L O GY 7 2 ( 2 0 17 ) 10 2 7 – 10 2 9

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journal homepage:

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[(Fig._1)TD$FIG]

Fig. 1

–

Subgroup analysis for overall survival among patients receiving nivolumab and cabozantinib according to prior sunitinib or pazopanib.

CI = confidence interval.