Nonomura Norio, Ito Taito, Sato Masashi, Morita Makiko, Kajita Masahiro, Oya Mototsugu
Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Medical Department, Merck Biopharma Co., Ltd., Tokyo, Japan, an affiliate of Merck KGaA.
Int J Urol. 2025 Mar;32(3):293-299. doi: 10.1111/iju.15646. Epub 2024 Dec 19.
Clinical trials have demonstrated the efficacy and safety of avelumab + axitinib in patients with advanced clear cell renal cell carcinoma (ccRCC). However, information is limited regarding the activity of avelumab + axitinib in patients with non-clear cell RCC (nccRCC). In Japan, post-marketing surveillance (PMS) of patients with RCC receiving avelumab + axitinib treatment in general clinical practice was undertaken. We report ad hoc analyses of PMS data according to RCC pathological classification.
Of 328 patients with RCC who received ≥1 dose of avelumab and were enrolled between December 2019 and May 2021, 271 (82.6%) had ccRCC, 22 (6.7%) had nccRCC, and 35 (10.7%) had missing or unknown RCC pathology. Among patients with nccRCC, pathological subtypes were papillary in 12 (3.7%), translocation in 3 (0.9%), acquired cystic disease associated in 3 (0.9%), chromophobe in 2 (0.6%), mucinous tubular and spindle cell in 1 (0.3%), and Bellini duct in 1 (0.3%).
Among patients with ccRCC or nccRCC, any-grade adverse drug reactions of safety specifications occurred in 140 (51.7%) and 15 (68.2%), and of grade ≥3 in 48 (17.7%) and 6 (27.3%), respectively. The objective response rate in patients with ccRCC or nccRCC was 36.9% and 22.7%, respectively; in patients with papillary tumors, it was 33.3%. Median overall survival was not reached in patients with ccRCC or nccRCC, and 12-month overall survival rates were 86.8% and 76.7%, respectively.
Overall, subgroup analyses of PMS data suggest that avelumab + axitinib improved clinical outcomes in nccRCC in addition to ccRCC.
临床试验已证明阿维鲁单抗联合阿昔替尼治疗晚期透明细胞肾细胞癌(ccRCC)患者的疗效和安全性。然而,关于阿维鲁单抗联合阿昔替尼治疗非透明细胞肾细胞癌(nccRCC)患者的活性信息有限。在日本,开展了在一般临床实践中接受阿维鲁单抗联合阿昔替尼治疗的肾细胞癌患者的上市后监测(PMS)。我们根据肾细胞癌的病理分类报告了PMS数据的临时分析。
在2019年12月至2021年5月期间入组的328例接受≥1剂阿维鲁单抗治疗的肾细胞癌患者中,271例(82.6%)为ccRCC,22例(6.7%)为nccRCC,35例(10.7%)肾细胞癌病理类型缺失或未知。在nccRCC患者中,病理亚型为乳头状12例(3.7%),易位性3例(0.9%),获得性囊性疾病相关性3例(0.9%),嫌色细胞性2例(0.6%),黏液性肾小管和梭形细胞性1例(0.3%),贝氏管癌1例(0.3%)。
在ccRCC或nccRCC患者中,安全性指标的任何级别药物不良反应分别发生在140例(51.7%)和15例(68.2%),≥3级分别发生在48例(17.7%)和6例(27.3%)。ccRCC或nccRCC患者的客观缓解率分别为36.9%和22.7%;乳头状肿瘤患者的客观缓解率为33.3%。ccRCC或nccRCC患者的中位总生存期未达到,12个月总生存率分别为86.8%和76.7%。
总体而言,PMS数据的亚组分析表明,阿维鲁单抗联合阿昔替尼除了改善ccRCC患者的临床结局外,还改善了nccRCC患者的临床结局。