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This study investigated the impact of relative dose intensity (RDI) on the effectiveness and safety of immuno-oncology plus tyrosine kinase inhibitor (IO-TKI) therapy in Japanese patients with renal cell carcinoma (RCC). A total of 145 patients receiving first-line treatment were analyzed: 55 received IO-TKI therapy and 90 received immuno-oncology combination (IO-IO) therapy. Patients in the IO-TKI group were divided based on an RDI threshold of 80% into high- and low-RDI groups. Median progression-free survival (mPFS) was significantly longer in the IO-TKI group compared to the IO-IO group (P < 0.05), while no significant difference in median overall survival (mOS) was observed (P = 0.53). Interestingly, the mOS tended to be shorter in the IO-TKI high-RDI group than in the IO-TKI low-RDI (P = 0.05) and IO-IO groups (P = 0.13). Moreover, treatment discontinuation due to adverse effects occurred earlier in the IO-TKI high-RDI group (P < 0.05). An association was found between RDI ≥ 80% in IO-TKI therapy, discontinuation due to adverse events, and poor prognosis. Careful dose adjustment of TKIs may be necessary to optimize outcomes in Japanese patients with RCC receiving IO-TKI combination therapy.

Immune checkpoint inhibitor (ICI)-based combination therapy has revolutionized first-line treatment outcomes for metastatic renal cell carcinoma (mRCC). In this study, we aimed to retrospectively analyze real-world clinical outcomes and toxicities of first-line ICI-based combination therapies, specifically nivolumab plus ipilimumab (IO+IO) and ICIs plus tyrosine kinase inhibitors (IO+TKI), in Japanese patients with mRCC aged ≥ 75 years compared with non-older adult patients. We retrospectively enrolled 156 patients with mRCC who received first-line IO+IO or IO+TKI between September 2018 and June 2024 at eight Japanese institutions. Patients were categorized into an older adult group (≥ 75 years, n=49) and a non-older adult group (< 75 years, n=107). We evaluated objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs). The overall ORR (47% vs. 59%, p=0.43) and DCR (86% vs. 83%, p=0.65) were comparable between groups. No significant differences were observed in PFS (median: 15.5 vs. 17.0 months, p=0.78) or OS (NA vs. 52.2 months, p=0.61). In the IO+IO regimen, the ORR, DCR, PFS, OS, and AE rates were comparable across age groups. However, in the IO+TKI regimen 　×cohort, the ORR was significantly lower in older adults (55% vs. 81%, p=0.04), and treatment discontinuation due to AEs was significantly higher in older adults (60% vs. 32%, p=0.02), with a shorter time to discontinuation despite no difference in the initial TKI dose and RDI. The non-older adult group showed significantly better PFS with IO+TKI compared with IO+IO (hazard ratio: 2.37, p=0.02). In contrast, in the older adult group, PFS and OS were approximately equivalent between the two regimens. Our real-world data indicated that ICI-based combination therapies are effective in patients with mRCC aged ≥75 years, with outcomes largely non-inferior to non-older adult patients. However, the comparable efficacy of IO+TKI and IO+IO in the older adult group, which may differs from that in the non-older adult group, highlights the importance of understanding the distinct characteristics of each regimen for individualized treatment selection and careful management, particularly regarding AE monitoring and dose adjustment in older adult patients receiving IO+TKI.

Skin-related adverse events (AEs) induced by apalutamide occur frequently in Japanese patients with prostate cancer. However, biomarkers for predicting these skin-related AEs have not yet been identified. Therefore, this study investigated whether the proportion of eosinophils could serve as a predictive biomarker for skin-related AEs in Japanese patients with prostate cancer treated with apalutamide. A total of 109 patients were enrolled in this study. Among them, 79 patients with prostate cancer who received apalutamide were categorized into two groups: the skin AE group (n = 45) and the non-skin AE group (n = 34), based on whether they experienced skin-related AEs of any grade. The eosinophil proportions in baseline samples collected before treatment were then analyzed. The baseline eosinophil proportion was significantly higher in the skin AE group compared with the non-skin AE group ( < 0.05). The optimal cut-off value of the eosinophil proportion for predicting skin-related AEs of any grade was 1.8% (area under the receiver operating characteristic curve [AUC] = 0.768). In multivariate analysis, an eosinophil proportion ≥1.8% was identified as an independent factor associated with skin-related AEs of any grade (odds ratio, 13.3; 95% confidence interval, 3.82-46.4; < 0.05). The baseline eosinophil proportion may serve as a predictive biomarker for skin-related AEs of any grade in Japanese patients with prostate cancer treated with apalutamide.

Background Immune checkpoint inhibitors (ICIs) can cause severe immune‐related adverse events (irAEs). However, biomarkers for irAEs common to different types of ICIs and cancers have not been reported. This study examined whether eosinophils can be used as a predictor of irAEs. Methods Six hundred fourteen patients with cancer (esophageal, gastric, head and neck, lung, melanoma, renal cell, urothelial, and other cancer) received anti‐PD‐1, anti‐PD‐L1, or anti‐CTLA‐4 plus anti‐PD‐1 therapy. The patients were divided into two groups depending on whether they experienced irAEs (irAE group) or not (non‐irAE group). Eosinophils were examined before the two‐course treatment. Results Patients in the irAE group who received anti‐PD‐1 or anti‐CTLA‐4 plus anti‐PD‐1 therapy had higher eosinophils before the two‐course treatment than those in the non‐irAE group (p < 0.05). The eosinophils in the anti‐PD‐L1 therapy group tended to increase in the irAE group. Furthermore, eosinophils in gastric, head and neck, lung, melanoma, renal, and urothelial cancers were significantly higher in the irAE group than in the non‐irAE group (p < 0.05). The optimal cutoff value for eosinophils against irAEs was 3.0% (area under the curve = 0.668). In multivariate analyses, eosinophils of ≥3.0% were an independent factor for irAEs (odds ratio: 2.57, 95% CI: 1.79–3.67). Conclusion An increased eosinophil before the two‐course treatment may be a predictor of irAEs in various cancers treated with different ICIs.

Background/Objectives: Nivolumab plus ipilimumab (IO–IO) provides durable clinical benefit in metastatic renal cell carcinoma (mRCC), yet long-term real-world data focusing on progression-free and treatment-free (PF–TF) survival remain limited. This study aimed to evaluate the long-term outcomes of IO–IO with a particular focus on the frequency and clinical characteristics of PF–TF. Methods: We retrospectively analyzed 63 patients with mRCC treated with first-line IO–IO across eight institutions with a minimum potential follow-up of five years. Progression-free survival (PFS), PFS2, and overall survival (OS) were assessed. PF–TF was defined as absence of disease progression and any cancer-directed therapy at the five-year landmark. Clinical and treatment-related factors were compared between patients with and without PF–TF. Results: The median PFS, PFS2, and OS were 7.5 (95% confidence interval [CI], 5.1–13.3), 26.2 (95% CI, 13.6–46.6), and 47.4 months (95% CI, 29.3–not reached), respectively. At 5 years, 11 patients (17%) achieved PF–TF. Baseline characteristics, IMDC risk classification, and peripheral blood biomarkers were not predictive of PF–TF. PF–TF was associated with the absence of bone metastases, presence of lymph node metastases, and occurrence of immune-related adverse events (irAEs), as well as the delayed onset of irAEs. No PF–TF patients required corticosteroid pulse therapy, and durable PF–TF was observed even after early treatment discontinuation due to adverse events. Conclusions: IO–IO demonstrated sustained long-term efficacy in real-world practice, with a subset achieving durable PF–TF. These findings highlight IO–IO as a strategy capable of providing long-term disease control with reduced treatment burden in selected patients with mRCC.

There is an unmet need to predict immune‐related adverse events (irAEs) in patients receiving immune checkpoint inhibitors. This study aimed to examine whether eosinophils can predict irAEs in metastatic urothelial carcinoma (mUC). In this multicenter cohort study, we retrospectively examined eosinophil before (baseline sample) and 3 weeks after treatment (3‐week sample) in 124 patients with mUC treated with pembrolizumab between January 2018 and October 2024. We divided the patients into two groups depending on whether they had experienced an irAE (irAE group) or not (non‐irAE group). The variation in eosinophil proportion from baseline to 3 weeks was significantly higher in the irAE group than in the non‐irAE group (non‐irAE, 2.4%–3.1%; irAE, 2.2%–4.3%; p < 0.05). Notably, the variation in eosinophils from baseline to 3 weeks in patients with bladder cancer was significantly higher in the irAE group than in the non‐irAE group (non‐irAE, 2.5%–2.8%; irAE, 1.9%–4.1%; p < 0.05), but not in upper urinary tract urothelial cancer (non‐irAE, 2.2%–3.7%; irAE, 2.8%–4.4%; p = 0.97). The optimal cutoff value for eosinophils in patients with bladder cancer against the occurrence of any‐grade irAEs was 5.0% (area under the curve = 0.655). Multivariable analyses showed that eosinophil levels ≥ 5.0% increased the risk of any‐grade irAEs in patients with bladder cancer (odds ratio 3.61, 95% confidence interval, 1.00–13.0). An eosinophil proportion ≥ 5.0% may be an effective biomarker for evaluating pembrolizumab‐induced irAEs in patients with mUC, particularly those with bladder cancer.

Apalutamide (Apa) is a key therapeutic agent for prostate cancer. Despite its efficacy, Apa is known to induce several drug-metabolizing enzymes including cytochrome P450 3A4 (CYP3A4), raising concerns about drug-drug interactions (DDIs). This study reports a rare case of a sustained DDI between Apa and cyclosporine (CsA)-a CYP3A4 substrate-in a patient with metastatic hormone-sensitive prostate cancer (mHSPC) and primary pure red cell aplasia (PRCA). We further investigated whether Apa could activate pregnane X receptor (PXR), a key nuclear receptor that regulates CYP3A4 expression. With informed consent, residual blood samples were used to measure serum Apa concentration. To assess the potential of Apa in activating PXR, a reporter gene assay and a CYP3A4 mRNA induction test were performed. A 75-year-old man with mHSPC was treated with Apa and leuprorelin. He developed PRCA and was administered CsA (5 mg/kg/day) on Day 1. Despite a target trough concentration ( ) of 150-200 ng/mL, the of CsA remained subtherapeutic (34 ng/mL on Day 5), even after dose escalation to 10 mg/kg/day ( : 66 ng/mL on Day 7), suspecting a DDI with Apa. On Day 8, Apa was discontinued and the CsA dosage was reduced to 5 mg/kg/day. The Apa concentrations measured on Days 13, 26, and 34 were 1.1, 0.15, and 0.07  g/mL, respectively, and the of CsA increased to 45, 82, and 134 ng/mL, respectively. In vitro experiments demonstrated that Apa was a strong activator of PXR and capable of inducing . Apa induced CYP3A4 via the PXR pathway, leading to a sustained DDI with CsA. Careful monitoring is necessary when Apa is coadministered with CYP3A4 substrates.