Comparison of Outcomes Between African American and European American Patients With Metastatic Clear Cell Renal Cell Carcinoma Receiving Immune Checkpoint Inhibitors

Immune checkpoint inhibitors (ICIs) and ICI/TKI combinations are standard first-line treatments for metastatic renal cell carcinoma (mRCC), yet Black patients have been underrepresented in trials. This retrospective study of 2592 patients with metastatic renal cell carcinoma (mRCC) from the Flatiron database assessed racial differences in outcomes between Black and White patients receiving first-line ICI-based treatments or sunitinib. No significant differences in progression-free survival were found between racial groups, suggesting that ICIbased therapies should be considered the standard of care for both Black and White patients. Background and Objective: Immune checkpoint inhibitors (ICIs) and ICI/tyrosine kinase inhibitor (TKI) (ICI-based) combinations are standard first-line treatment (tx) options for patients with metastatic clear cell renal cell carcinoma (mRCC). However, only 1% of patients enrolled in trials studying these agents were Blacks. Methods: Patients with mRCC who received front-line ICI-based tx or sunitinib after 2011 were included from the Flatiron Health electronic record-derived database. We analyzed progression-free survival in African American (Black) and European American (White) patients and tested the interaction between treatment type and race. Multivariable Cox proportional hazards models were used to assess associations with outcomes. Key Findings and Limitations: Of 2,592 eligible pts, 2,379 (91.8%) were White, and 213 (8.2%) were Black. Of these, 1453 (56%) received ICI-based tx and 1139 (44%) received sunitinib. IMDC favorable, intermediate/poor and unknown risk was noted among 6%, 77.5% and 16.4% of White patients and 3.3%, 86.8% and 9.9% of Black patients. Median age was 64 years. There was no significant difference in PFS between Black and White patients receiving ICI-based treatment compared to sunitinib [hazard ratio (HR) for interaction between treatment type and race was 1.063 (0.78-1.45, P = .7)]. The interaction term between race and treatment type showed that there was no evidence of a differential treatment effect by race in the first 10 months (HR = 0.931 (0.791.10); P = .40), however significantly improved after 10 months (HR = 0.697 (0.56-0.87); P = .001). The retrospective nature of the study is a limitation Conclusions and Clinical Implications: The study found no significant difference in treatment effects between White and Black patients receiving ICI-based first-line treatment and should be the standard of care for both Black and White patients. Patient Summary: We reviewed Flatiron databases of patients with mRCC from both Black and White populations, finding that ICI-based therapy should be considered the standard of care for patients from both racial backgrounds.