Systemic therapies in renal cell carcinoma with brain metastases: A comparative meta-analysis of immunotherapy and tyrosine kinase inhibitors.

• DOI: 10.1200/jco.2025.43.5_suppl.559
• Publication Date: 2025-02-18T14:35:11Z
• Authors: Abdur Jamil; Zaheer Qureshi; Roshmita Bardhan; Mohsin Ahmad; Insija Ilyas Selene

559 Background: Renal cell carcinoma (RCC) with brain metastases presents a clinical challenge. Management remains unclear, as systemic therapy data are limited and many trials exclude patients active metastases. Current treatment primarily involves CNS-targeted radiation (e.g., stereotactic radiosurgery whole-brain therapy), while therapies like tyrosine kinase inhibitors (TKIs) immune checkpoint (ICIs) underexplored. This meta-analysis evaluates the efficacy of treatments whether these should continue to be excluded from trials. Methods: A systematic search PubMed, CENTRAL, MEDLINE, Google Scholar was conducted through October 2024, focusing on studies mRCC treated ICIs, TKIs, or their combination. ICI included nivolumab, ipilimumab, pembrolizumab, atezolizumab, avelumab, TKIs sorafenib, sunitinib, cabozantinib. Case reports, ongoing trials, narrative reviews, meta-analyses were excluded. Primary endpoints complete response (CR), partial (PR), objective rate (ORR), overall survival (OS). Statistical analyses used fixed/random-effects models based heterogeneity. Results: Nineteen involving 947 included. The pooled analysis showed an ORR for ICIs 29.9%, CR 3.4% PR 28.9%. Brain-specific ORR, CR, 27.5%, 10.8%, 17.9%. alone 11.7%, 1.3% 11.6%. 38.1%, 6.9%, 29.5%. Only one study reported ICI-TKI combinations, 0%. Survival significantly worse OS metastasis plus (HR: 2.06, p=0.001) 2.51, p=0.02) compared those without Conclusions: had superior rates combinations in similar between TKIs. Given poor prognosis further research is needed determine if they Larger prospective required confirm findings optimize treatment.