Efficacy of immune checkpoint inhibitors (ICI) treatment in special populations of metastatic renal cell carcinoma (mRCC).
Bibliographic record
Abstract
673 Background: Immunotherapies involving a PD-1/PD-L1 immune-checkpoint inhibitor (ICI) are highly effective treatments for mRCC and are now standard of care. Nevertheless, special populations such as patients (pts) with renal impairment (RI) and elderly age were either excluded or underrepresented in registration trials. Here we investigate the efficacy of ICI in mRCC with RI and age above 70 years (yrs). Methods: We utilized the mRCC Princess Margaret database to select pts treated with an ICI agent from May 2005 to May 2018. Renal impairment (RI) was defined as a baseline creatinine > 1.5 ULN or clearance of creatinine < 40 mL/min. Pts were classified as elderly if their age was over 70yrs at the time of ICI initiation. Descriptive statistics and survival analysis were performed. Results: Of 387 pts, 74 received an ICI agent or combination. Mean age was 61yrs and median creatinine was 105 umol/L. Fifty-four pts (73%) were treated with single agent PD-1/PD-L1 ICI and 46 (62%) received treatment as 2nd line. Respectively, 19 (26%), 43 (58%) and 12 (16%) pts were classified as International Metastatic RCC Database Criteria (IMDC) prognostic groups good, intermediate and poor. Of 73 pts with available creatinine levels, 7 (9.5%) were classified as having RI. Ten pts (13.5%) were > 70yrs. Despite not statistically different, pts with RI had worse median overall survival (OS) compared to pts without RI: 7.8 months (m) vs. 28.3m (p=.10). There was no OS difference between pts > 70yrs compared to ≤ 70yrs: not reached (NR) vs. 28m (p=.65). Both RI and elderly patients had no differences in distribution of IMDC prognostic groups compared controls. Conclusions: RI was associated with a non-statistical detriment in OS of mRCC treated with ICI. RI may be a surrogate for comorbid factors that impact OS and needs further analysis in a larger patient sample. Age does not affect ICI efficacy in our cohort. Larger studies to confirm our findings in these special populations are necessary.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".