Abstract: SA-PO180
Incidence of Rash and Palmar-Plantar Erythrodysesthesia 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
- Waguespack, Dia Rose, McGovern Medical School - UTHealth - Houston, 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
- Lin, Maung htain K., Charles Wilson VA outpatient clinic, Houston, Texas, United States
- Htut, Thura Win, Aberdeen Royal Infirmary, Colchester, Essex, United Kingdom
- Nguyen, Kim Phung L., University of Texas Health Science Center at Houston, McGovern Medical School , Houston, Texas, United States
- Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Lubbock, Texas, United States
- Swarup, Sriman, Texas Tech University Health Science Center, Lubbock, Texas, United States
- Thein, Kyaw Z., The University of Texas MD Anderson Cancer Center, Lubbock, Texas, United States
Background
Renal cell carcinoma (RCC) is the most common form of kidney cancer and clear cell RCC, the most common histology, harbors genetic abnormalities involved in angiogenesis via production of vascular endothelial growth factor (VEGF). Sunitinib has been the standard first-line treatment of advanced RCC for the past decade with notable dermatologic toxicities. We performed a combined analysis of randomized controlled trials (RCT) to determine the risk of rash and palmar-plantar erythrodysesthesia (PPE) with newer first-line combination therapies with checkpoint inhibitors.
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 rash was reported in 295 (15.8%) vs 205 (11.0%) in control group with RR of 1.43 (95% CI: 1.21 –1.69, P < 0.001). High-grade rash was noted in 13 (0.7%) in study arm vs 6 (0.3%) in control arm (RR, 1.41; 95% CI: 0.36 –5.51, P = 0.62). Any-grade PPE was 289 (15.5%) in study arm vs 741 (39.8%) in control arm. The pooled RR was statistically significant at 0.21 (95% CI: 0.06 –0.71, P = 0.01). High-grade PPE was noted in 47 (2.5%) vs 124 (6.6%) in control group with RR of 0.20 (95% CI: 0.03 –1.59, P = 0.13).
Conclusion
Upfront checkpoint inhibitors combination therapy notably decreased the risk of any-grade PPE, a major cause of morbidity and one of the feared dermatological toxicities, with a RR of 0.21, despite increasing the risk of any-grade rash.