Abstract Code: IUC25517-85
Title: First‑line TKI, ipilimumab–nivolumab, and lenvatinib–pembrolizumab in metastatic non–clear cell RCC: real‑world survival across two UK centres
- Maamoun 1, M. Al-Essa 2, I. Pedley 3, A. Azzabi 3, S. Grumett 2, M. Elgendy 3
(1) Newcastle hospitals – United Kingdom, (2) Queen Elizabeth Hospital – University Hospitals Birmingham NHS Foundation Trust – United Kingdom, (3) Newcastle Hospitals – United Kingdom
Background:
The optimal first‑line strategy for metastatic non clear cell RCC (nccRCC) remains unclear, with limited direct comparisons between VEGFR‑TKIs, dual‑immune checkpoint inhibitors, and TKI/IO combinations.
Methods:
Retrospective analysis of 41 patients treated between 2012–2025. Demographics, IMDC risk, and histology were collected. PFS was measured from therapy start to progression/death; OS from metastatic diagnosis to death/last follow‑up. Kaplan–Meier medians and 95% CIs were calculated for the whole cohort and treatment specific subgroups: single‑agent TKI, ipilimumab–nivolumab, and lenvatinib–pembrolizumab.
Results:
Forty one patients were included (median age 56; 56% male); IMDC: favourable 22%, intermediate 61%, poor 17%. Histologies included papillary (23/41), chromophobe (6/41), unclassified (6/41), MIT‑family (5/41), and oncocytic (1/41). For the overall population, mOS was 24.15 mo (95% CI 24.38–49.41) and mPFS 13.93 mo (95% CI 16.10–49.41).
ipilimumab–nivolumab (n=6): mOS 24.38 mo (95% CI 24.38–28.81); mPFS 5.32 mo (95% CI 5.32–28.81).
lenvatinib–pembrolizumab (n=15): mOS 14.42 mo (95% CI 13.04–NR); mPFS 12.32 mo (95% CI 12.32–NR).
Single‑agent TKI (n=19): mOS 24.15 mo (95% CI 18.79–49.41); mPFS 11.63 mo (95% CI 13.93–49.41).
Small cohort sizes and event sparsity contributed to wide CIs.
Conclusions:
In this real‑world cohort, OS appeared similar between ipilimumab–nivolumab and single‑agent TKI, whereas lenvatinib–pembrolizumab was associated with a shorter OS but the longest PFS, approximately 12 months. The limited sample size restricts the strength and generalisability of these findings. Larger, multi‑centre datasets are needed to validate regimen‑level differences in first‑line nccRCC.