Treatment of advanced (metastatic) kidney cancer has improved considerably over the past decade with the use of immunotherapy and targeted therapy. However, oncologists often have difficulty deciding which first-line treatment is best for their patients because of a lack of a direct comparison between combination treatments. The ARON-1 study compared two combination treatments: pembrolizumab plus axitinib and nivolumab plus cabozantinib in the real world.

The study included 760 patients with metastatic kidney cancer who were being treated according to standard clinical practice in their hospital. Most patients (607 patients) were treated with pembrolizumab plus axitinib, while 153 patients were treated with nivolumab plus cabozantinib.

Overall survival time was similar for both combination treatments (average overall survival time was over 4 and a half years for  pembrolizumab plus axitinib). However the average time to when the treatment stopped working and the cancer started growing again  (progression-free survival) was better for patients treated with nivolumab plus cabozantinib (two years and 4 months compared to one year and 4 months for patients treated with pembrolizumab plus axitinib).

Patients with moderate-risk disease, clear cell kidney cancer, and lung metastases had greater benefit from the nivolumab plus cabozantinib combination.

In conclusion, this study supports the use of nivolumab plus cabozantinib as a first-line treatment in selected groups of advanced kidney cancer patients, and provides evidence for the importance of individualised treatment for metastatic kidney cancer.

However, this was a retrospective observational study, which has limitations when comparing treatments and lacked information from scans, side effects, quality of life, and subsequent treatments. Further work is needed to compare treatments in a prospective clinical trial and to find biomarkers to predict response to treatment.

However, this study will help clinicians make more informed and personalised treatment decisions.

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