Network Meta-Analysis for an Efficacy Assessment of Avelumab Axitinib in the First-Line Treatment of International Metastatic RCC Database Consortium (IMDC) Favorable Risk Patients With Advanced Renal Cell Carcinoma (ARCC)
Author(s)
Mairead Kearney, MB, BCh, MPH, MBA, MSc Econ1, Anna-Maria Fontrier, Ph.D2, Tina Alexopoulos, BSc, MSc2, Yu-Heng Liu, PharmD, MSc3, Neil Roskell, MSc4.
1Global Value Demonstration, Market Access and Pricing, Biopharma, Global Operations, Merck Healthcare KGaA, Darmstadt, Germany, 2Merck Serono Ltd., an affiliate of Merck KGaA, Feltham, United Kingdom, 3Lumanity, Sheffield, United Kingdom, 4Lumanity, Manchester, United Kingdom.
1Global Value Demonstration, Market Access and Pricing, Biopharma, Global Operations, Merck Healthcare KGaA, Darmstadt, Germany, 2Merck Serono Ltd., an affiliate of Merck KGaA, Feltham, United Kingdom, 3Lumanity, Sheffield, United Kingdom, 4Lumanity, Manchester, United Kingdom.
OBJECTIVES: Relative treatment effects of avelumab + axitinib (ave + axi) were compared with alternative first-line (1L) treatments for patients with aRCC (IMDC favorable risk population). Relevant treatment comparators with reported results in this subgroup included sunitinib, nivolumab + ipilimumab (nivo + ipi), pembrolizumab + lenvatinib (pem + len) and nivolumab + cabozantinib (nivo + cabo).
METHODS: Subgroup data from four randomized controlled trials (RCTs) were suitable for indirect treatment comparisons (JAVELIN Renal 101 [ave + axi, n=188], CheckMate 214 [nivo + ipi, n=249], CheckMate 9ER [nivo + cabo, n=146] and CLEAR [pem + len, n=234]). Study heterogeneity was assessed based on trial design and patient characteristics, which were generally comparable across studies. IMDC favorable risk subgroup data for overall survival (OS) and progression-free survival (PFS) were analyzed in Bayesian network meta-analyses (NMAs) where sunitinib was a common comparator across all 4 included RCTs.
RESULTS: OS NMA results showed that ave + axi performed numerically better than sunitinib (hazard ratio [HR]: 0.78; 95% credible interval [CrI], 0.52-1.17), nivo + cabo (HR: 0.73; 95% CrI, 0.38-1.41), and pem + len (HR: 0.83; 95% CrI, 0.44-1.56); and similar to nivo + ipi (HR: 0.98; 95% CrI, 0.59-1.62). For PFS, ave + axi performed better than sunitinib (HR: 0.75; 95% CrI, 0.54-1.04) and nivo + ipi (HR: 0.42; 95% CrI 0.26-0.68); similar to nivo + cabo (HR: 1.04; 95% CrI 0.63-1.72); and worse than pem + len (HR: 1.50; 95% CrI 0.93-2.43]).
CONCLUSIONS: These findings support the role of ave + axi as a 1L treatment option for IMDC favorable risk aRCC patients. Results have shown that ave + axi performed numerically better than 3 of the 4 comparator treatments for OS and better than 2 of the 4 comparators for PFS, with numerically similar results to 1 comparator in both OS and PFS.
METHODS: Subgroup data from four randomized controlled trials (RCTs) were suitable for indirect treatment comparisons (JAVELIN Renal 101 [ave + axi, n=188], CheckMate 214 [nivo + ipi, n=249], CheckMate 9ER [nivo + cabo, n=146] and CLEAR [pem + len, n=234]). Study heterogeneity was assessed based on trial design and patient characteristics, which were generally comparable across studies. IMDC favorable risk subgroup data for overall survival (OS) and progression-free survival (PFS) were analyzed in Bayesian network meta-analyses (NMAs) where sunitinib was a common comparator across all 4 included RCTs.
RESULTS: OS NMA results showed that ave + axi performed numerically better than sunitinib (hazard ratio [HR]: 0.78; 95% credible interval [CrI], 0.52-1.17), nivo + cabo (HR: 0.73; 95% CrI, 0.38-1.41), and pem + len (HR: 0.83; 95% CrI, 0.44-1.56); and similar to nivo + ipi (HR: 0.98; 95% CrI, 0.59-1.62). For PFS, ave + axi performed better than sunitinib (HR: 0.75; 95% CrI, 0.54-1.04) and nivo + ipi (HR: 0.42; 95% CrI 0.26-0.68); similar to nivo + cabo (HR: 1.04; 95% CrI 0.63-1.72); and worse than pem + len (HR: 1.50; 95% CrI 0.93-2.43]).
CONCLUSIONS: These findings support the role of ave + axi as a 1L treatment option for IMDC favorable risk aRCC patients. Results have shown that ave + axi performed numerically better than 3 of the 4 comparator treatments for OS and better than 2 of the 4 comparators for PFS, with numerically similar results to 1 comparator in both OS and PFS.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO170
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Urinary/Kidney Disorders