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Selected Publication:

Fluhrer, H.
Überlebenszeiten von Patient/innen mit Nierenzellkarzinom- Änderungen durch die Einführung von Tyrosinkinase-Hemmern und Immuncheckpoint-Inhibitoren – eine real-life Analyse
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 56 [OPEN ACCESS]


Authors Med Uni Graz:
Barth Dominik Andreas
Pichler Martin

Background: The treatment landscape of metastatic renal cell carcinoma (mRCC) has substantially advanced over the last three decades, whereby data from controlled clinical trials indicate significant improvements regarding patients’ overall survival (OS) in highly select patient cohorts. The aim of this study is to evaluate the impact of potentially game changing drugs on patients’ outcomes by comparing three different historical mRCC treatment eras. Methods: 914 mRCC patients who were diagnosed between July 1985 and September 2020 were included into this observational study and assigned to three different treatment eras (‘cytokine’, ‘1st generation tyrosine kinase inhibitors [TKIs]’, ‘modern TKIs/immunotherapy’) based on the EMA-approval dates of sunitinib (July 2006) and nivolumab (June 2015) in mRCC treatment. OS was considered the primary study endpoint. Kaplan-Meier analyses, log-rank tests, and uni- and multivariable Cox regression models were performed. Results: OS was significantly longer in patients of the modern TKIs/immunotherapy era (median OS not reached) as compared to the cytokine (2.4 years) and 1st generation TKIs era (1.7 years, all p<0.001). Moreover, patients of the modern TKIs/immunotherapy era demonstrated a significantly better prognosis (HR=0.41, 95%CI 0.31-0.54, p<0.001) compared to those of the cytokine era, while no statistically significant difference was observed between the cytokine and the 1st generation TKIs era cohort (HR=1.10, 95%CI 0.87-1.39, p=0.420) Subgroup analyses stratified by the International Metastatic RCC Database Consortium (IMDC) risk groups showed a significantly longer OS in the modern TKIs/immunotherapy era as compared to 1st generation TKIs and cytokines across all IMDC risk groups. Conclusion: Significant advances in the systemic medical treatment of mRCC during the recent decade and the introduction of immunotherapy exerted a major impact on patient outcomes in terms of OS in a real-life population.

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