Presentation (CTI)

OBJECTIVES: Advanced renal cell carcinoma (RCC) has undergone substantial therapeutic evolution with the introduction of immune checkpoint inhibitor and tyrosine kinase inhibitor combination therapies. However, direct comparative evidence among available first-line regimens remains limited. This study aimed to evaluate the efficacy, safety, patient-reported outcomes (PROs), and feasibility of conducting a network meta-analysis (NMA) in advanced RCC.
METHODS: A systematic literature review was conducted to identify studies evaluating first-line immunotherapy-based combination therapies in advanced or metastatic RCC. Data on progression-free survival (PFS), overall survival (OS), objective response rate (ORR), safety outcomes, quality of life (QoL), and subgroup analyses were extracted and qualitatively synthesized. NMA feasibility was assessed based on population comparability, intervention similarity, outcome consistency, and availability of common comparators.
RESULTS: Five key studies were included. Nivolumab plus cabozantinib demonstrated the most favorable efficacy outcomes, with a median PFS of 16.6 months versus 8.3 months for sunitinib and a PFS hazard ratio (HR) of 0.51 (95% CI: 0.41-0.64). Improvements in OS (HR 0.60; 95% CI: 0.40-0.89) and ORR (55.7% vs. 27.1%) were also observed. Across studies, immunotherapy-based combinations were associated with improved symptom control, delayed deterioration in QoL, and maintained daily functioning. Grade ≥3 treatment-related adverse events were reported but were generally manageable using established clinical management strategies. Most studies used sunitinib as a common comparator, creating a connected evidence network suitable for indirect treatment comparisons.
CONCLUSIONS: Immunotherapy-based combination therapies provide meaningful clinical benefits in advanced RCC. Among evaluated regimens, nivolumab plus cabozantinib demonstrated the most favorable overall efficacy profile. The available evidence supports the feasibility of NMA to enable indirect treatment comparisons, treatment ranking, and evidence-based decision making for first-line advanced RCC management.