ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2023 August;75(4):460-70

DOI: 10.23736/S2724-6051.23.05369-7

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Geographical differences in the management of metastatic de novo renal cell carcinoma in the era of immune-combinations

Camillo PORTA ^{1, 2}, Aristotelis BAMIAS ³, Roubini ZAKOPOULOU ³, Zin W. MYINT ⁴, Nicolò CAVASIN ⁵, Roberto IACOVELLI ⁶, Martin PICHLER ⁷, Jindrich KOPECKY ⁸, Jakub KUCHARZ ⁹, Mimma RIZZO ¹, Luca GALLI ¹⁰, Thomas BÜTTNER ¹¹, Ugo DE GIORGI ¹², Ravindran KANESVARAN ¹³, Ondřej FIALA ¹⁴, Enrique GRANDE ¹⁵, Paolo A. ZUCALI ^{16, 17}, Ray M. KOPP ¹⁸, Giuseppe FORNARINI ¹⁹, Maria T. BOURLON ²⁰, Sarah SCAGLIARINI ²¹, Javier MOLINA-CERRILLO ²², Gaetano AURILIO ²³, Marc R. MATRANA ²⁴, Renate PICHLER ²⁵, Carlo CATTRINI ²⁶, Tomáš BÜCHLER ^{27, 28}, Francesco MASSARI ²⁹ ✉, Veronica MOLLICA ²⁹, Emmanuel SERONT ³⁰, Fabio CALABRÒ ³¹, Alvaro PINTO ³², Rossana BERARDI ³³, Anca ZGURA ³⁴, Giulia MAMMONE ³⁵, Jawaher ANSARI ³⁶, Francesco ATZORI ³⁷, Rita CHIARI ³⁸, Orazio CAFFO ³⁹, Giuseppe PROCOPIO ^{40, 41}, Kaisa SUNELA ⁴², Maria BASSANELLI ⁴³, Cinzia ORTEGA ⁴⁴, Francesco GRILLONE ⁴⁵, Johannes LANDMESSER ⁴⁶, Sara MERLER ⁴⁷, Carlo MESSINA ⁴⁸, Zsófia KÜRONYA ⁴⁹, Alessandra MOSCA ⁵⁰, Dipen BHUVA ⁵¹, Daniele SANTINI ⁵², Nuno VAU ⁵³, Franco MORELLI ⁵⁴, Lorena INCORVAIA ⁵⁵, Sara E. REBUZZI ^{56, 57}, Giandomenico ROVIELLO ⁵⁸, Andrey SOARES ^{59, 60}, Ignacio O. ZABALZA ¹⁵, Alessandro RIZZO ⁶¹, Renato BISONNI ⁶², Francesco PIERANTONI ⁵, Giulia SORGENTONI ⁶³, Fernando S. MONTEIRO ^{59, 64}, Nicola BATTELLI ⁶³, Sebastiano BUTI ⁶⁵, Matteo SANTONI ⁶³

¹ Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy; ² Chair of Oncology, Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy; ³ Second Propedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; ⁴ Markey Cancer Center, University of Kentucky, Lexington, KY, USA; ⁵ Oncology3 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy; ⁶ Oncologia Medica, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ⁷ Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; ⁸ Department of Clinical Oncology and Radiotherapy, University Hospital of Hradec Kralove, Hradec Kralove, Czech Republic; ⁹ Department of Uro-Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; ¹⁰ Oncology Unit2, University Hospital of Pisa, Pisa, Italy; ¹¹ Department of Urology, University Hospital Bonn UKB, Bonn, Germany; ¹² Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy; ¹³ Division of Medical Oncology, National Cancer Center Singapore, Singapore; ¹⁴ Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic; ¹⁵ Department of Medical Oncology, MD Anderson Cancer Center of Madrid, Madrid, Spain; ¹⁶ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; ¹⁷ Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; ¹⁸ Clinical Oncology, Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia; ¹⁹ IRCCS San Martino University Hospital Genoa, Italy; ²⁰ Department of Hematology and Oncology, Salvador Zubirán National Institute of Medical and Nutritional Sciences, Mexico City, Mexico; ²¹ Unit of Oncology, Azienda Ospedaliera di Rilievo Nazionale Cardarelli of Naples, Naples, Italy; ²² Department of Medical Oncology, Hospital Ramón y Cajal, Madrid, Spain; ²³ Medical Oncology Division of Urogenital and Head and Neck Tumors, European Institute of Oncology IEO IRCCS, Milan, Italy; ²⁴ Department of Internal Medicine, Hematology/Oncology, Ochsner Medical Center, New Orleans, LA, USA; ²⁵ Department of Urology, Medical University of Innsbruck, Innsbruck, Austria; ²⁶ Department of Medical Oncology, Maggiore della Carità University Hospital, Novara, Italy; ²⁷ Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic; ²⁸ Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic; ²⁹ Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; ³⁰ Department of Medical Oncology, Jolimont Hospital Center, Haine Saint Paul, Belgium; ³¹ Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy; ³² Department of Medical Oncology, La Paz University Hospital, Madrid, Spain; ³³ Department of Medical Oncology, AOU Ospedali Riuniti delle Marche, Marche Polytechnic University, Ancona, Italy; ³⁴ Department of Oncology-Radiotherapy, Prof. Dr. Alexandru Trestioreanu Institute of Oncology, University of Medicine and Pharmacy, Bucharest, Romania; ³⁵ Department of Radiological, Oncological and Anatomo-Pathological Science, Sapienza University of Rome, Rome, Italy; ³⁶ Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates; ³⁷ Unit of Medical Oncology, University Hospital of Cagliari, Cagliari, Italy; ³⁸ Unit of Oncology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; ³⁹ Unit of Medical Oncology, Santa Chiara Hospital, Trento, Italy; ⁴⁰ Department of Medical Oncology, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy; ⁴¹ Department of Medical Oncology, Ospedale Maggiore of Cremona, Cremona, Italy; ⁴² Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; ⁴³ Department of Medical Oncology1, IRCCS Regina Elena National Cancer Institute, Rome, Italy; ⁴⁴ Division of Oncology, Institute for Cancer Research and Treatment, Asl Cn2 Alba-Bra, Alba, Cuneo, Italy; ⁴⁵ Unit of Medical Oncology, Pugliese-Ciaccio Hospital, Catanzaro, Italy; ⁴⁶ Clinic of Urology, Lübeck, Germany; ⁴⁷ Section of Oncology, Department of Medicine, University of Verona School of Medicine, Verona University Hospital, Verona, Italy; ⁴⁸ Unit of Oncology, A.R.N.A.S. Civico, Palermo, Italy; ⁴⁹ Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Budapest, Hungary; ⁵⁰ Department of Oncology, Candiolo Cancer Institute, IRCCS-FPO, Candiolo, Turin, Italy; ⁵¹ Department of Medical Oncology, Army Hospital Research and Referral, New Delhi, India; ⁵² Department of Radiological, Oncological and Pathological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy; ⁵³ Department of Urologic Oncology, Champalimaud Clinical Center, Lisbon, Portugal; ⁵⁴ Unit of Medical Oncology, Gemelli Molise Hospital, Sacred Heart Catholic University, Campobasso, Italy; ⁵⁵ Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; ⁵⁶ Department of Medical Oncology, San Paolo Hospital, Savona, Italy; ⁵⁷ Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa, Genoa, Italy; ⁵⁸ Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy; ⁵⁹ Latin American Cooperative Oncology Group - LACOG, Porto Alegre, Brazil; ⁶⁰ Albert Einstein Israelite Hospital, São Paulo, Brazil; ⁶¹ Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico Don Tonino Bello, IRCCS Istituto Tumori Giovanni Paolo II IRCCS Cancer Institute, Bari, Italy; ⁶² Unit of Medical Oncology, A. Murri Hospital, Fermo, Italy; ⁶³ Unit of Oncology, Hospital of Macerata, Macerata, Italy; ⁶⁴ Department of Oncology and Hematology, Santa Lucia Hospital, Brasília, Brazil; ⁶⁵ Unit of Medical Oncology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy

BACKGROUND: The upfront treatment of metastatic renal cell carcinoma (mRCC) has been revolutionized by the introduction of immune-based combinations. The role of cytoreductive nephrectomy (CN) in these patients is still debated. The ARON-1 study (NCT05287464) was designed to globally analyze real-world data of mRCC patients receiving first-line immuno-oncology combinations. This sub-analysis is focused on the role of upfront or delayed partial or radical CN in three geographical areas (Western Europe, Eastern Europe, America/Asia).
METHODS: We conducted a multicenter retrospective observational study in mRCC patients treated with first-line immune combinations from 55 centers in 19 countries. From 1152 patients in the ARON-1 dataset, we selected 651 patients with de novo mRCC. 255 patients (39%) had undergone CN, partial in 14% and radical in 86% of cases; 396 patients (61%) received first-line immune-combinations without previous nephrectomy.
RESULTS: Median overall survival (OS) from the diagnosis of de novo mRCC was 41.6 months and not reached (NR) in the CN subgroup and 24.0 months in the no CN subgroup, respectively (P<0.001). Median OS from the start of first-line therapy was NR in patients who underwent CN and 22.4 months in the no CN subgroup (P<0.001). Patients who underwent CN reported longer OS compared to no CN in all the three geographical areas.
CONCLUSIONS: No significant differences in terms of patients’ outcome seem to clearly emerge, even if the rate CN and the choice of the type of first-line immune-based combination varies across the different Cancer Centers participating in the ARON-1 project.

KEY WORDS: Immunotherapy; Nephrectomy; Carcinoma, renal cell; Survival