Abstract: SA-PO191
Incidence of Hypertension and Hypothyroidism in Patients with Advanced Renal Cell Carcinoma Treated with First-Line Combination Therapy with Checkpoint Inhibitors
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Hninn, Wut yi, UTHealth, Houston, Texas, United States
- Sultan, Anita, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
- Ahmed, Vaqar, Dallas Nephrology Associates, Lubbock, Texas, United States
- Swarup, Sriman, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
- Htut, Thura Win, Aberdeen Royal Infirmary, Colchester, Essex, United Kingdom
- Waguespack, Dia Rose, McGovern Medical School - UTHealth - Houston, Houston, Texas, United States
- Khairalla, Hanan A., University of Texas, Houston, Texas, United States
- Pankow, Jonathan D., University of Texas Medical Center, Houston, Texas, United States
- Lin, Maung htain K., Charles Wilson VA outpatient clinic, Houston, Texas, United States
- Thein, Kyaw Z., The University of Texas MD Anderson Cancer Center, Lubbock, Texas, United States
Background
Utilizing immunotherapies and antiangiogenic agents has become a fundamental paradigm shift in the treatment of advanced renal cell carcinoma (RCC). Inhibition of vascular endothelial growth factor (VEGF) has antiangiogenic and immunomodulatory effects. Combination of these therapies has also shown to have synergistic antitumor activities and survival benefits. Yet, there are considerable safety concerns. We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of hypertension and hypothyroidism.
Methods
PUBMED, MEDLINE, EMBASE databases and meeting abstracts from inception through May 2019 were queried. RCTs utilizing upfront checkpoint inhibitors combination therapy in patients with advanced RCC were incorporated. The primary meta- analytic approach was a random effects model using the Mantel-Haenszel (MH) method. It was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI).
Results
Four phase III RCTs including 3758 patients with advanced RCC were eligible. The study arm used nivolumab+ ipilimumab, pembrolizumab+ axitinib, avelumab+ axitinib or atezolizumab+ bevacizumab while control arm utilized sunitinib. The randomization ratio was 1:1 in all studies. The I2 statistic for heterogeneity was 98%, suggesting some heterogeneity among RCTs. Any-grade hypertension was reported in 567 (30.4%) vs 746 (40.1%) in control group with RR of 0.54 (95% CI: 0.27 –1.07, P = 0.08). High-grade hypertension was noted in 273 (14.6%) in study arm vs 317 (17.0%) in control arm (RR, 0.63; 95% CI: 0.30 –1.30, P = 0.21). Any-grade hypothyroidism was 450 (24.1%) in study arm vs 388 (20.8%) in control arm. The pooled RR was not statistically significant at 1.22 (95% CI: 0.76 –1.95, P = 0.41). High-grade hypothyroidism was noted in 5 (0.27%) vs 4 (0.22%) in control group with RR of 1.23 (95% CI: 0.33 –4.67, P = 0.76).
Conclusion
Our meta-analysis demonstrated that there was no significant increase in the risk of hypertension and hypothyroidism in upfront combination therapy group compared to standard sunitinib arm, despite achieving higher survival benefits.