Abstract: SA-PO0222
Safety and Survival Analysis of Sequential Systemic Anticancer Treatment in Patients with ESKD and Metastatic Renal Cell Carcinoma
Session Information
- Onconephrology: MGRS, HSCT, Electrolytes, RCC, and More
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Milanez, Tomaz, Univerzitetni klinicni center Ljubljana, Ljubljana, Slovenia
- Srinivasan, Vinay, Rowan University Cooper Medical School, Camden, New Jersey, United States
- Arnol, Miha, Univerzitetni klinicni center Ljubljana, Ljubljana, Slovenia
- Ocvirk, Janja, Univerzitetni klinicni center Ljubljana, Ljubljana, Slovenia
- Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background
Systemic anticancer therapy (SACT) enhances overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) despite the risk of serious adverse events (SAEs). Patients undergoing sequential SACT may experience kidney function deterioration, potentially progressing to end-stage kidney disease (ESKD). Patients on hemodialysis (HD) are at risk for major bleeding events, and certain VEGFR-TKIs also pose bleeding risks. The incidence of SAEs such as bleeding and infection, and their effects on OS in mRCC patients with ESKD receiving SACT are not well defined.
Methods
This retrospective study included patients with mRCC and ESKD who received SACT with VEGFR inhibitors, immune checkpoint inhibitors (ICI), or mTOR inhibitors, either alone or in combination, at the Institute of Oncology Ljubljana, Slovenia, from December 2009 to May 2025. Medical records provided data on bleeding and infection frequency and severity. OS was measured from SACT initiation to death. Mean and median OS were calculated across all risk groups according to IMDC.
Results
We identified 39 patients with mRCC and ESKD that were treated with SACT. Their median age was 70 years and predominantly male (79.5%). According to IMDC, 30.8% had a good prognosis; 69.2% had intermediate or poor prognosis. Nineteen patients received at least one cycle of ICI, and nine started with combination ipilimumab and nivolumab. Most were already on HD (64.1%), with some developing ESKD during treatment. Bleeding episodes before SACT occurred in 23.1%, including severe cases of grade 4 epistaxis and hemorrhages requiring urgent intervention. During SACT, 17.9% experienced grade 4 GIB, and 71.8% had grade 3/4 infections, including sepsis and septic shock. The median OS was 32 months, with a mean OS of 42.2 months.
Conclusion
Serious bleeding and infections are expected complications in mRCC and ESKD patients treated with sequential SACT. Clinicians should consider these life-threatening complications when selecting SACT type and duration. Due to significant management challenges, treatment should be guided by specialized onco-nephrology services. The IMDC risk model and primary outcomes for mRCC and ESKD patients require further evaluation in prospective trials to improve treatment strategies, effectiveness, and safety.
Funding
- NIDDK Support