Patient Perspective on Medical Conditions Post Immune Checkpoint Therapy in Advanced Renal Carcinoma
Main Article Content
Keywords
Patient Perspective , Post Immune Checkpoint Therapy , renal cell carcinoma
Abstract
Immune checkpoint therapy (ICI) has enabled induction of remission in advanced renal cell carcinoma RCC. ICI toxicities can persist as chronic health conditions. We developed a patient survey to assess changes in medical comorbidities after ICI. The survey was developed by the Kidney Cancer Research Alliance (KCCure), with multidisciplinary representation from urologic surgeons, medical oncologists, and patient advocates. The survey was broadcast between July 2022 and September 2022 to patients via website, mailing lists, and social media platforms. Patient perspective on changes to any medical conditions were evaluated in the survey questionnaire. Of 1062 patients that responded, 399 were self-identified as being metastatic and 289 reported to be treated with ICI. Eighty-five percent of respondents were from the United States. The most common conditions noted were thyroid dysfunction in 80 patients, hypertension in 50 patients, chronic kidney disease in 23 patients, heart disease in 10 patients, and diabetes mellitus (DM) in 13 patients. Immune disorders developed in 26 (9%) patients. The limitations are the survey had minimal participation from minority populations. Multiple medical conditions were noted to either emerge or worsen as a result of ICI-based therapies in RCC. Awareness of this information as a starting point should stimulate the development of survivorship programs for renal cancer. A survey of patients with advanced kidney cancer showed that some medical conditions such as thyroid dysfunction, hypertension, heart and kidney disease, DM, and immune conditions were newly diagnosed and/or persisted after immune therapy.
References
2. Toni KC, Thomas P, Mauricio B, Escudier B, Bourlon MT, Zurawski B, et al. Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N. Engl. J. Med. 2021 Mar 4;384(9):829–841. https://doi.org/10.1056/NEJMoa2026982
3. Tannir N, Escudier B, McDermott D, Burotto M, Choueiri TK, Hammers HJ, et al. Nivolumab plus ipilimumab (NIVO+IPI) vs sunitinib (SUN) for first-line treatment of advanced renal cell carcinoma (aRCC): Long-term follow-up data from the phase 3 CheckMate 214 trial. J. Clin. Oncol. 42, 2024 (suppl 4; abstr 363).
4. Burotto M, Powles T, Escudier B, Apolo AB, Bourlon MT, Shah AY, et al. Nivolumab plus cabozantinib vs sunitinib for first-line treatment of advanced renal cell carcinoma (aRCC): 3-year follow-up from the phase 3 CheckMate 9ER trial. J. Clin. Oncol. 41, 2023 (suppl 6; abstr 603). https://doi.org/10.1200/JCO.2023.41.6_suppl.603
5. Motzer R , Boris Alekseev , Sun-Young R. Porta C, Eto M, Powles T, et al. Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. N. Engl. J. Med. 2021 Apr 8;384(14):1289–1300.
6. Motzer R, Porta C, Masatoshi E, Grunwald V, Hutson TE, Alekseev B, et al. Lenvatinib plus pembrolizumab versus sunitinib in first-line treatment of advanced renal cell carcinoma: Final prespecified overall survival analysis of CLEAR, a Phase III Study. J. Clin. Oncol. 2024 Apr 10;42(11):1222–1228.
7. Rini BI, Elizabeth R Plimack 1, Viktor Stus, Gafanov R, Hawkins R, Nosov D, .et al. Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N. Engl. J. Med. 2019 Mar 21;380(12):1116–1127.
8. Powles T, Plimack ER, Soulieres D, Waddell T, Stus V, Gafanov R, et al. Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): Extended follow-up from a randomized, open-label, phase 3 trial. Lancet Oncol. 2020; 21:1563–1573.
9. Choueiri TK, Tomczak P, Park SH, Venugopal B, Ferguson T, Chang Y, et al. Adjuvant pembrolizumab after nephrectomy in renal-cell carcinoma. N. Engl. J. Med. 2021 Aug19;385(8):683–694.
10. Goodman RS, Lawless A, Woodford R, Fa’ak F, Tipirneni A, Patrinely RJ, et al. Extended follow-up of chronic immune-related adverse events following adjuvant anti-PD-1 therapy for high-risk resected melanoma. JAMA Netw. Open. 2023;6(8):e2327145–52. https://doi.org/10.1001/jamanetworkopen.2023.27145
11. Patrinely JR, Johnson R, Lawless AR, Bhave P, Sawyers A, Dimitrova M, et al. Chronic immune-related adverse events following adjuvant anti-PD-1 therapy for high-risk resected melanoma. JAMA Oncol. 2021 May 1;7(5):744–748.
12. Barron CC, Isabella Stefanova, Yevin Cha, Elsolh K, Zereshkian A, Gaafour N, et al. Chronic immune-related adverse events in patients with cancer receiving immune checkpoint inhibitors: A systematic review. J. Immunother. Cancer. 2023 Aug;11(8): 1-7.
13. John DB, Nebhan CA, Moslehi JJ, Balko JM. Immune-checkpoint inhibitors: Long-term implications of toxicity. Nat. Rev. Clin. Oncol. 2022; 19(4): 254–267.
14. Rozeman EA, Hoefsmit EP, Reijers ILM, Saw RPM, Versluis JM, Krijgsman O, et al. Survival and biomarker analyses from the OpACIN-neo and OpACIN neoadjuvant immunotherapy trials in stage III melanoma. Nat. Med. 2021;27(2):256–263. https://doi.org/10.1038/s41591-020-01211-7
15. Owen CN, Bai X, Quah T, Lo SN, Allayous C, Callaghan S, et al. Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma. Ann. Oncol. 2021;July 32 (7) 917-925
16. Wang DY, Salem JE, Cohen JV, Chandra S, Menzer C, Ye F, et al. Fatal toxic effects associated with immune checkpoint inhibitors: A systematic review and meta-analysis. JAMA Oncol. 2018;4(12):1721–1728. https://doi.org/10.1001/jamaoncol.2018.392
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Sumanta Pal, Oncology City of Hope, Duarte CA, Rogel Cancer Center University of Michigan
N/A