Hypertransaminasemia in metastatic renal cell carcinoma patients receiving immune-based combinations: a meta-analysis

Plain language summaryIn our study, we aimed to determine the risk for developing alterations in liver function in treatment-naive patients with metastatic renal cell carcinoma, receiving an immunotherapic compound plus a tyrosine-kinase inhibitor or sunitinib alone. We found that combination treatment, compared with sunitinib, is associated with an increased risk to present this type of liver's toxicity, even a high-grade one. Aims: We performed a meta-analysis to assess the relative risk (RR) of all-grade and grade 3-4 hypertransaminasemia in studies comparing immune-based combinations with sunitinib in treatment-naive patients with advanced renal cell carcinoma. Materials & methods: Outcomes of interest included all-grade and grade 3-4 hypertransaminasemia measured as RRs and 95% confidence intervals (CIs). Results: RRs for all-grade hypertransaminasemia were 1.73 (95% CI: 1.25-2.4) and 1.63 (95% CI: 1.25-2.12) in patients receiving immunocombinations and sunitinib, respectively. The pooled RRs for grade 3-4 hypertransaminasemia were 3.24 and 3.04 in patients treated with immunocombinations or sunitinib. Conclusion: Immune-based combinations were associated with higher hypertransaminasemia risk. Physicians should pay attention to these common but overlooked events. Careful monitoring of tolerability remains a crucial need.