Retrospective Evaluation of Patients Receiving Targeted Therapy and Immunotherapy in Metastatic Renal Cell Cancer

Objective: Renal cell cancer (RCC) constitutes 2-3% of all cancers. Distant metastasis is present in 25-30% of patients at the time of diagnosis. Metastatic RCC is multi-drug resistant cancers. Before twenty years, immunomodulatory drugs (such as interferon-alpha and IL-2) were the first line treatment as standard. But treatment response rates with these agents were 15-30%, and they had serious side effects. Today, targeted the-rapies and immunotherapies have been developed with a better understanding of the pathogenesis of RCC. These treatments are agents that are more effective and more tole-rable. In our study, we aimed to evaluate the clinical and tumor characteristics, treat-ments, side effects and survival results of patients treated with the diagnosis of metasta-tic RCC. Materials and Methods: In our study, 97 patients who were diagnosed with metastatic RCC who applied to Gaziantep University Medical Faculty Hospital Medical Oncology Department between September 2012 and December 2019 were evaluated retrospecti-vely. Kaplan-Meier method was used for survival analysis and log-rank test was used for comparisons. P <0.05 value was considered statistically significant. Results: The median age of the patients was 67 (19-87). The patients 64 (66%) of were male (M) and 33 (34%) were female (F), and the M / F ratio was 1.9. In 77 of the pati-ents (79.3%) there was a history of comorbid illness. The most common histopathologi-cal subtype was clear cell cancer (63.9%). The most common metastasis areas of the pa-tients are; lung (82.4%), lymph node (60.8%), bone (47.4%) and liver (26.8%). Metasta-sectomy was performed in 16.4% of the patients. The overall survival (OS) time after metastasis was 20.7 (95% CI, 1.7; 17.3-24.19) months. It was 14.4 ± 3.1 (8.3-20.5) months in patients without nephrectomy and in nephrectomies, it was 25.4 ± 3.8 (17.9-33) months. There was a statistically significant difference between the groups (p = 0.026). There was no difference in survival for sunitinib and pazopanib treatments app-lied to the patients in the second line of treatment. Third-line therapy was performed in 56 patients. There was OS benefit (26.5 months) with nivolumab treatment. Survival was shorter in patients with hypercalcaemia (22.1 months vs. 17.5 months). Conclusion: The treatments used in the second step were not superior to each other. Therefore, the side effects and costs of the agents should be taken into consideration in the selection of the agent to be used. It was observed that the benefit of survival was higher with the use of immunotherapy agents.