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. 2025 Jul 25;25(1):1220.
doi: 10.1186/s12885-025-14654-3.

Impact of first-line tyrosine kinase inhibitor selection on survival outcomes with second-line nivolumab in metastatic renal cell carcinoma

Omer Faruk Kuzu  1 , Hatice Bolek  2   3 , Elif Sertesen Camoz  4 , Hilal Karakas  5 , Serhat Sekmek  5 , Saadet Sim  6 , Selver Isık  7 , Murat Günaltılı  8 , Aysun Fatma Akkus  9 , Deniz Tural  10 , Cagatay Arslan  11 , Sema Sezin Goksu  12 , Ozlem Nuray Sever  13 , Cengiz Karacin  4 , Mehmet Ali Nahit Sendur  5 , Nuri Karadurmus  1 , Emre Yekedüz  2   3   14 , Yüksel Ürün  15   16
Affiliations

Impact of first-line tyrosine kinase inhibitor selection on survival outcomes with second-line nivolumab in metastatic renal cell carcinoma

Omer Faruk Kuzu et al. BMC Cancer. .

Abstract

Introduction: Access to first-line immune checkpoint inhibitor (ICI) combinations in metastatic renal cell carcinoma (mRCC) remains limited in many low- and middle-income countries. Consequently, tyrosine kinase inhibitors (TKIs) are still widely used. This study investigates the impact of first-line sunitinib versus pazopanib on survival outcomes with second-line nivolumab.

Methods: We conducted a retrospective analysis of 245 patients with mRCC from the Turkish Oncology Group Kidney Cancer Consortium Database. Patients received first-line sunitinib or pazopanib, followed by second-line nivolumab. Primary endpoints were time to treatment failure (TTF) and overall survival (OS). Subgroup analyses were performed based on IMDC risk classification and presence of sarcomatoid features.

Results: A total of 245 patients who were treated with sunitinib or pazopanib monotherapy as first-line treatment followed by nivolumab as second-line treatment were included in this study. Median TTF following nivolumab initiation was similar between prior sunitinib and pazopanib groups (7.79 vs 7.72 months; p = 0.892). Median OS-2 was 27.21 months with prior sunitinib and 18.92 months with prior pazopanib (p = 0.496). In patients with sarcomatoid features (n = 20), those pretreated with pazopanib demonstrated numerically longer OS-2 compared to sunitinib (p = 0.023), although the small sample size limits definitive conclusions.

Conclusion: No significant differences in survival outcomes were observed between first-line sunitinib and pazopanib before nivolumab in mRCC. In the small subgroup with sarcomatoid features, pazopanib pre-treatment was associated with a numerically longer survival. These findings warrant cautious interpretation and further prospective validation, especially in resource-constrained settings.

Keywords: Metastatic renal cell cancer; Nivolumab; Pazopanib; Sunitinib.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ankara University Faculty Ethics Committee (date:11/09/2024, approval number I09-701–24) and it was carried out in accordance with the Code of Ethics of the World Medical Association also known as a declaration of Helsinki. Due to the retrospective nature of the study the use of anonymized data, no informed consent was required as per the ethics committee approval. Consent for publication: Not applicable. Competing interests: Yüksel Ürün: Advisory work —Abdi-İbrahim, Astellas, AstraZeneca, Bristol Myers-Squibb, Deva, Eczacıbaşı, Gen ilaç, Gilead, GSK, Janssen, Merck, MSD, Novartis, Pfizer, Roche; travel, honoraria and consultation fees—Abdi-İbrahim, Astellas, Bristol Myers-Squibb, Deva, Eczacıbaşı, Gen ilaç, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Roche. All remaining authors have declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curve for time to treatment failure
Fig. 2
Fig. 2
Kaplan–Meier curve for overall survival-2
Fig. 3
Fig. 3
Kaplan–Meier curve for overall survival-1
Fig. 4
Fig. 4
Kaplan–Meier curves for time to treatment failure and overall survival for patients without sarcomatoid features (A and C) and patients with sarcomatoid features (B and D)
See this image and copyright information in PMC

References

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