Clinical Outcomes of Metastatic Renal Carcinoma Following Disease Progression to Programmed Death (PD)-1 or PD-L1 Inhibitors (IO): A Meet-URO Group Real World Study (Meet-Uro 7)

Daniele Santini, Marco Stellato, Ugo De Giorgi, Francesco Pantano, Delia De Lisi, Chiara Casadei, Marco Maruzzo, Davide Bimbatti, Emanuele Naglieri, Sebastiano Buti, Melissa Bersanelli, Rocco De Vivo, Giuseppe Di Lorenzo, Andrea Sbrana, Elena Verzoni, Mariella Soraru', Giuseppe Fornarini, Claudia Mucciarini, Francesco Grillone, Enrico MiniFrancesca Vignani, Laura Attademo, Sandro Pignata, Giuseppe Procopio

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: The aim of our study was to collect data about of the outcome of metastatic renal cell carcinoma patients who progressed after immune checkpoint inhibitors in order to enhance data about efficacy and safety of treatment beyond immune-oncology (IO).

MATERIALS AND METHODS: A total of 162 eligible patients, progressing to IO, were enrolled from 16 Italian referral centers adhering to the Meet-Uro association. Baseline characteristics, outcome data and toxicities were retrospectively collected. Descriptive analysis was made using median values and ranges. Kaplan-Meier method and Mantel-Haenszel log-rank test were performed to compare differences between groups.

RESULTS: A total of 111 patients (68.5%) were treated after IO progression. In all, 51 patients (31.5%) did not receive further treatment for clinical deterioration. Median IO progression free survival (PFS) was 4 months (95% confidence interval [CI]: 3.1-4.8). IO-PFS tends to be longer in patients reporting adverse events (AE) of any grade (5.03 [95% CI: 3.8-6.1] vs. 2.99 [95% CI: 2.4-3.5] months P=0.004). Subsequent therapies included cabozantinib (n=79, 48%), everolimus (n=11, 6.7%), and others (n=21, 12.9%).Median PFS post-IO was 6.5 months (95% CI: 5.1-7.8). Cabozantinib showed longer PFS compared with everolimus (7.6 mo [95% CI: 5.2-10.1] vs. 3.2 mo [95% CI: 1.8-4.5]) (hazard ratio: 0.2; 95% CI: 0.1026-0.7968) and other drugs (4.3 mo [95% CI: 1.3-7.4]) (hazard ratio: 0.6; 95% CI: 0.35-1.23). All grade AE were reported in 83 patients (74%) and G3 to G4 AE in 39 patients (35%). Target therapies post-IO showed median overall survival of 14.7 months (95% CI: 0.3-21.4).

CONCLUSIONS: In our real world experience after progression to IO, vascular endotelial groth factor-tyrosine kinase inhibitors, given to patients, proved to be active and safe choices. Cabozantinib was associated with a better outcome in terms of median PFS.

Original languageEnglish
Pages (from-to)121-125
Number of pages5
JournalAm. J. Clin. Oncol.
Issue number3
Publication statusPublished - Mar 1 2021


  • Aged
  • Anilides/administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols/adverse effects
  • Carcinoma, Renal Cell/drug therapy
  • Disease Progression
  • Everolimus/administration & dosage
  • Female
  • Humans
  • Immune Checkpoint Inhibitors/adverse effects
  • Italy
  • Kidney Neoplasms/drug therapy
  • Male
  • Middle Aged
  • Nivolumab/adverse effects
  • Programmed Cell Death 1 Receptor/metabolism
  • Pyridines/administration & dosage
  • Retrospective Studies
  • Treatment Outcome


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