Immunotherapy versus standard of care in metastatic renal cell carcinoma. A systematic review and meta-analysis
A partir d'une revue systématique de la littérature (5 865 patients), cette méta-analyse compare l'efficacité, du point de vue de la survie globale, de la survie sans progression et du taux de réponse globale, des immunothérapies et des traitements anticancéreux standards, chez les patients atteints d'un carcinome à cellules rénales de stade métastatique
Background : Recently, immune checkpoint inhibitors against PD-1/PD-L1 or CTLA4 have emerged as new treatments for metastatic renal cell carcinoma (mRCC), despite discrepancy between their effects on OS and PFS. We performed a meta-analysis of randomized trials comparing immunotherapy to standard of care (SOC) in mRCC. Methods : Searching the MEDLINE/PubMed, Cochrane Library and ASCO Meeting abstracts prospective studies were identified. Data extraction was conducted according to the PRISMA statement. The measured outcomes were OS, PFS, and ORR. Results : A total of 2832 patients were available for evaluation of OS, and 3033 for PFS and ORR. Compared to SOC, immunotherapy improved OS (HR=0.75; 95%CI 0.66–0.85; p<0.001), and PFS (HR=0.88; 95%CI 0.80–0.97; p=0.009). The PFS benefit was not confirmed when considering patients treated in first-line only (p=0.10). Conversely, significant ORR improvement was found in patients treated in first-line only (HR=1.14; 95%CI 1.02–1.28; p=0.03) but not in the overall population. Conclusions : Immunotherapy improved OS compared to SOC in mRCC, irrespective of treatment line. In first-line, immunotherapy also increased the ORR compared to sunitinib. A lack of correlation between OS and PFS was confirmed, the latter to be used cautiously for the design and interpretation of trials involving immunotherapy in mRCC.