#ESMO26 Can plasma KIM-1 help identify who needs a TKI added to immunotherapy in advanced ccRCC?

🧬 Post-hoc COSMIC-313 analysis of KIM-1 dynamics:

🔹 Higher baseline KIM-1 → poor-risk disease, no prior nephrectomy + greater tumor burden

🔹 With nivo/ipi, >30% KIM-1 ↓ at week 3 predicted:
• Better PFS: HR 0.46
• Better OS: HR 0.55
• ORR: 59% vs 31%

🚨This association was NOT seen with cabo/nivo/ipi → suggesting distinct biology

🤖 A baseline RNA-seq ML model predicted KIM-1 non-decreasers. In these predicted IO-resistant patients, adding cabozantinib improved:
• PFS: HR 0.63
• ORR: 49% vs 34%
• DCR: 90% vs 71%

🔑 KIM-1 dynamics may help distinguish patients who do well with dual IO from those who may benefit from TKI escalation

@urotoday