Effectiveness of modern immunotherapy in combination treatment of patients with renal cancer and bone metastases

Aim. To evaluate the effectiveness of modern immunotherapy in combination treatment of patients with renal cancer (RC) and bone metastases (BM).

Materials and methods. Retrospective analysis of 19 patients with RC BM who received nivolumab and ipilimumab at standard dose and frequency in the 1st line of treatment and palliative orthopedic surgeries at the Moscow City Oncological Hospital No. 62 between 2015 and 2023.

Results. Median follow-up was 17 months. Median progression-free survival (PFS) was 6 months (interquartile range (IQR) 4–10 months). One-year PFS was 13 %. Median overall survival (OS) was 13.0 months (IQR 10.5–18.0 months). One-year OS was 60 %, 2-years OS was 42 %, 3-year OS was 29 %. Disease control was achieved in 13 (68.4 %) patients: in 1 (5.3 %) – complete response, in 12 (63.1 %) – stable disease. Adverse events (AEs) of any grade were registered in 15 (79.0 %) patients. Grade III treatment-associated AEs were observed in 2 (10.5 %) patients. There was no therapy discontinuation due to AEs.

Analysis of the effect of the International Metastatic Renal Cell Carcinoma Database Consortium (IMDS) prognosis group on PFS showed insignificant trend towards higher median PFS in intermediate prognosis group compared to the unfavorable prognosis group (p = 0.073). IMDC prognosis group significantly affected OS. Median OS in the intermediate prognosis group was 9.5 months higher than in the unfavorable prognosis group: 16.0 and 6.5 months respectively (p = 0.002). Statistically significant prognosis factors affecting OS in patients with RC BM were concomitant lung and lymph node metastases. Median OS in patients with concomitant lung metastases was 9.0 months, without lung metastases – 16.5 months (log-rank, р = 0.004). Median OS in patients with lymph node metastases was 12.0 months, without lymph node metastases – 17.0 months (log-rank, р = 0.02).

Conclusion. In wide clinical practice, cytoreductive surgeries for symptomatic metastatic bone lesions clinically benefit patients with RC BM providing disease control, increased PFS and OS, improved quality of life.                                                                                                                                                                                                                                                                                            

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