Can we identify a preferred first-line strategy for sarcomatoid renal cell carcinoma? A network meta-analysis

Immunotherapy. 2022 Feb;14(2):145-153. doi: 10.2217/imt-2021-0157. Epub 2021 Nov 22.


Background: Combinations based on immune checkpoint inhibitors are the new first-line standard treatment for metastatic renal cell carcinoma. Sarcomatoid renal cell carcinoma (sRCC) has a dismal prognosis but good immunogenicity. Methods: The authors performed a network meta-analysis of Phase III randomized trials of immune checkpoint inhibitor-based combinations versus standard tyrosine kinase inhibitor monotherapy reporting data for sRCC. The end points were overall survival, progression-free survival and objective response rate. Results: Five trials comprising 569 sRCC patients (out of a total of 4409 metastatic renal cell carcinoma patients) were included. Nivolumab-cabozantinib was the highest ranking treatment for overall survival (p-score = 88%) and progression-free survival (p-score = 81%). Atezolizumab-bevacizumab had the highest rank for objective response rate (p-score = 80%). Conclusion: Despite some limitations, nivolumab-cabozantinib might be the preferred first-line option for sRCC in terms of efficacy.

Keywords: first-line treatment; immune checkpoint inhibitors; network meta-analysis; renal cell carcinoma; sarcomatoid; tyrosine kinase inhibitors.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anilides / therapeutic use
  • Carcinoma, Renal Cell / drug therapy*
  • Carcinoma, Renal Cell / immunology
  • Humans
  • Immune Checkpoint Inhibitors / therapeutic use*
  • Immunotherapy / methods*
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / immunology
  • Network Meta-Analysis
  • Nivolumab / therapeutic use
  • Protein Kinase Inhibitors / therapeutic use
  • Pyridines / therapeutic use


  • Anilides
  • Immune Checkpoint Inhibitors
  • Protein Kinase Inhibitors
  • Pyridines
  • cabozantinib
  • Nivolumab