BACKGROUND: The upfront treatment of metastatic renal cell carcinoma (mRCC) has been revolutionized by the introduction of immune-based combinations. The role of cytoreductive nephrectomy (CN) in these patients is still debated. The ARON-1 study (NCT05287464) was designed to globally analyze real-world data of mRCC patients receiving first-line immuno-oncology combinations. This sub-analysis is focused on the role of upfront or delayed partial or radical CN in three geographical areas (Western Europe, Eastern Europe, America/Asia). METHODS: We conducted a multicenter retrospective observational study in mRCC patients treated with first-line immune combinations from 55 centers in 19 countries. From 1152 patients in the ARON-1 dataset, we selected 651 patients with de novo mRCC. 255 patients (39%) had undergone CN, partial in 14% and radical in 86% of cases; 396 patients (61%) received first-line immune-combinations without previous nephrectomy. RESULTS: Median overall survival (OS) from the diagnosis of de novo mRCC was 41.6 months and not reached (NR) in the CN subgroup and 24.0 months in the no CN subgroup, respectively (P<0.001). Median OS from the start of first-line therapy was NR in patients who underwent CN and 22.4 months in the no CN subgroup (P<0.001). Patients who underwent CN reported longer OS compared to no CN in all the three geographical areas. CONCLUSIONS: No significant differences in terms of patients' outcome seem to clearly emerge, even if the rate CN and the choice of the type of first-line immune-based combination varies across the different Cancer Centers participating in the ARON-1 project.

2nd Propedeutic Department of Internal Medicine ATTIKON University Hospital National and Kapodistrian University of Athens School of Medicine Athens Greece

Albert Einstein Israelite Hospital São Paulo Brazil

Chair of Oncology Interdisciplinary Department of Medicine Aldo Moro University of Bari Bari Italy

Clinic of Urology Lübeck Germany

Clinical Oncology Sociedad de Oncología y Hematología del Cesar Valledupar Colombia

Department of Biomedical Sciences Humanitas University Pieve Emanuele Milan Italy

Department of Clinical Oncology and Radiotherapy University Hospital of Hradec Kralove Hradec Kralove Czech Republic

Department of Genitourinary Medical Oncology and Clinical Pharmacology National Institute of Oncology Budapest Hungary

Department of Hematology and Oncology Salvador Zubirán National Institute of Medical and Nutritional Sciences Mexico City Mexico

Department of Internal Medicine and Medical Specialties University of Genoa Genoa Italy

Department of Internal Medicine Hematology Oncology Ochsner Medical Center New Orleans LA USA

Department of Medical Oncology AOU Ospedali Riuniti delle Marche Marche Polytechnic University Ancona Italy

Department of Medical Oncology Army Hospital Research and Referral New Delhi India

Department of Medical Oncology Hospital Ramón y Cajal Madrid Spain

Department of Medical Oncology IRCCS Istituto Nazionale Tumori Foundation Milan Italy

Department of Medical Oncology IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori Meldola Forlì Cesena Italy

Department of Medical Oncology Jolimont Hospital Center Haine Saint Paul Belgium

Department of Medical Oncology La Paz University Hospital Madrid Spain

Department of Medical Oncology Maggiore della Carità University Hospital Novara Italy

Department of Medical Oncology MD Anderson Cancer Center of Madrid Madrid Spain

Department of Medical Oncology Ospedale Maggiore of Cremona Cremona Italy

Department of Medical Oncology San Paolo Hospital Savona Italy

Department of Medical Oncology Tawam Hospital Al Ain United Arab Emirates

Department of Medical Oncology1 IRCCS Regina Elena National Cancer Institute Rome Italy

Department of Oncology 1st Faculty of Medicine Charles University and Thomayer University Hospital Prague Czech Republic

Department of Oncology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Oncology and Hematology Santa Lucia Hospital Brasília Brazil

Department of Oncology and Radiotherapeutics Faculty of Medicine and University Hospital in Pilsen Charles University Pilsen Czech Republic

Department of Oncology Candiolo Cancer Institute IRCCS FPO Candiolo Turin Italy

Department of Oncology IRCCS Humanitas Research Hospital Rozzano Milan Italy

Department of Oncology Radiotherapy Prof Dr Alexandru Trestioreanu Institute of Oncology University of Medicine and Pharmacy Bucharest Romania

Department of Oncology San Camillo Forlanini Hospital Rome Italy

Department of Oncology Tays Cancer Center Tampere University Hospital Tampere Finland

Department of Radiological Oncological and Anatomo Pathological Science Sapienza University of Rome Rome Italy

Department of Radiological Oncological and Pathological Sciences Umberto 1 Polyclinic Hospital Sapienza University Rome Italy

Department of Uro Oncology Maria Sklodowska Curie National Research Institute of Oncology Warsaw Poland

Department of Urologic Oncology Champalimaud Clinical Center Lisbon Portugal

Department of Urology Medical University of Innsbruck Innsbruck Austria

Department of Urology University Hospital Bonn UKB Bonn Germany

Division of Medical Oncology A O U Consorziale Policlinico di Bari Bari Italy

Division of Medical Oncology National Cancer Center Singapore Singapore

Division of Oncology Department of Internal Medicine Medical University of Graz Graz Austria

Division of Oncology Institute for Cancer Research and Treatment Asl Cn2 Alba Bra Alba Cuneo Italy

IRCCS San Martino University Hospital Genoa Italy

Latin American Cooperative Oncology Group LACOG Porto Alegre Brazil

Markey Cancer Center University of Kentucky Lexington KY USA

Medical Oncology Division of Urogenital and Head and Neck Tumors European Institute of Oncology IEO IRCCS Milan Italy

Medical Oncology IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Oncologia Medica IRCCS A Gemelli University Polyclinic Foundation Rome Italy

Oncology Unit2 University Hospital of Pisa Pisa Italy

Oncology3 Unit Department of Oncology Istituto Oncologico Veneto IOV IRCCS Padua Italy

Section of Clinical Pharmacology and Oncology Department of Health Sciences University of Florence Florence Italy

Section of Medical Oncology Department of Surgical Oncological and Oral Sciences University of Palermo Palermo Italy

Section of Oncology Department of Medicine University of Verona School of Medicine Verona University Hospital Verona Italy

Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico Don Tonino Bello IRCCS Istituto Tumori Giovanni Paolo 2 IRCCS Cancer Institute Bari Italy

Unit of Medical Oncology A Murri Hospital Fermo Italy

Unit of Medical Oncology Department of Medicine and Surgery University Hospital of Parma University of Parma Parma Italy

Unit of Medical Oncology Gemelli Molise Hospital Sacred Heart Catholic University Campobasso Italy

Unit of Medical Oncology Pugliese Ciaccio Hospital Catanzaro Italy

Unit of Medical Oncology Santa Chiara Hospital Trento Italy

Unit of Medical Oncology University Hospital of Cagliari Cagliari Italy

Unit of Oncology A R N A S Civico Palermo Italy

Unit of Oncology Azienda Ospedaliera di Rilievo Nazionale Cardarelli of Naples Naples Italy

Unit of Oncology Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy

Unit of Oncology Hospital of Macerata Macerata Italy

References provided by Crossref.org

First-line immune-based combinations or sunitinib in favorable-risk metastatic renal cell carcinoma: a real-world retrospective comparison from the ARON-1 study

Real-World Primary Resistance to First-Line Immune-Based Combinations in Patients with Advanced Renal Cell Carcinoma (ARON-1)

Sex and survival outcomes in patients with renal cell carcinoma receiving first-line immune-based combinations