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<p>To update a network meta-analysis of first-line immunotherapy combinations in advanced renal cell carcinoma (RCC) using short-term data for primary analysis and long-term plus newly published randomized controlled trials (RCTs) for subgroup analyses. We searched PubMed, Embase, Web of Science, Cochrane Library, and Chinese databases for articles from inception to 22 December 2024, performing a Bayesian network meta-analysis. Overall survival (OS), progression-free survival (PFS), objective response rates (ORR), and adverse events (AEs) were assessed using hazard ratios (HRs) and odds ratios (OR) in all-risk and intermediate- and poor-risk subgroups. Fourteen articles and nine RCTs involving 6,193 patients and nine regimens were included. Pembrolizumab plus axitinib (HR: 0.57, 95% CI: 0.39–0.84) improved OS compared to atezolizumab plus bevacizumab. Pembrolizumab plus lenvatinib (HR: 0.57, 95% CI: 0.42–0.76) showed superior PFS to pembrolizumab plus axitinib with comparable efficacy to nivolumab plus cabozantinib (HR: 1.31, 95% CI: 0.96–1.78) and higher ORR versus pembrolizumab plus axitinib (OR: 0.61, 95% CI: 0.39–0.92). Rank probabilities identified pembrolizumab plus axitinib and pembrolizumab plus lenvatinib as optimal regimens in all-risk populations. Subgroup analyses prioritized pembrolizumab plus lenvatinib (PFS: 98.8%), toripalimab plus axitinib (OS: 77.3%), and pembrolizumab plus axitinib (ORR: 94.9%) for intermediate- and poor-risk patients. Conclusions require validation due to limited trials and methodological heterogeneity. In the first-line treatment of advanced RCC, pembrolizumab plus lenvatinib enhances survival with poorer safety versus nivolumab plus ipilimumab’s improved tolerability. Toripalimab plus axitinib may be associated with relatively greater efficacy in intermediate- and poor-risk patients.</p>

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Efficacy and safety of immunotherapy-based combination therapy as first-line treatment for advanced renal cell carcinoma: a systematic review and network meta-analysis

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Xiaoyu Ou,
  • Yan Li,
  • Mengru Zhan,
  • Tiantian Tao,
  • Pingyu Chen

摘要

To update a network meta-analysis of first-line immunotherapy combinations in advanced renal cell carcinoma (RCC) using short-term data for primary analysis and long-term plus newly published randomized controlled trials (RCTs) for subgroup analyses. We searched PubMed, Embase, Web of Science, Cochrane Library, and Chinese databases for articles from inception to 22 December 2024, performing a Bayesian network meta-analysis. Overall survival (OS), progression-free survival (PFS), objective response rates (ORR), and adverse events (AEs) were assessed using hazard ratios (HRs) and odds ratios (OR) in all-risk and intermediate- and poor-risk subgroups. Fourteen articles and nine RCTs involving 6,193 patients and nine regimens were included. Pembrolizumab plus axitinib (HR: 0.57, 95% CI: 0.39–0.84) improved OS compared to atezolizumab plus bevacizumab. Pembrolizumab plus lenvatinib (HR: 0.57, 95% CI: 0.42–0.76) showed superior PFS to pembrolizumab plus axitinib with comparable efficacy to nivolumab plus cabozantinib (HR: 1.31, 95% CI: 0.96–1.78) and higher ORR versus pembrolizumab plus axitinib (OR: 0.61, 95% CI: 0.39–0.92). Rank probabilities identified pembrolizumab plus axitinib and pembrolizumab plus lenvatinib as optimal regimens in all-risk populations. Subgroup analyses prioritized pembrolizumab plus lenvatinib (PFS: 98.8%), toripalimab plus axitinib (OS: 77.3%), and pembrolizumab plus axitinib (ORR: 94.9%) for intermediate- and poor-risk patients. Conclusions require validation due to limited trials and methodological heterogeneity. In the first-line treatment of advanced RCC, pembrolizumab plus lenvatinib enhances survival with poorer safety versus nivolumab plus ipilimumab’s improved tolerability. Toripalimab plus axitinib may be associated with relatively greater efficacy in intermediate- and poor-risk patients.