Introduction: Oligometastatic renal cell carcinoma is a frequent diagnosis for which very few randomized control studies (RCTs) have been conducted and still represent a challenge for clinicians. Over the past few years, the results of two Phase I/II trials on this issue, the RESORT (Sorafenib+SBRT) and the RAPPORT (Pembrolizumab+SBRT) have been published. In addition, at ASCO23 the Kaplan Meier curves regarding the M1-NED group of the KEYNOTE-564 (surgery on metastases+Pembro) has been presented. In this hypothesis generating work, we aimed to assess which of these approaches has the best outcomes. Methods: A comprehensive search for all published trials which included survival data on treatment for oligometastatic RCC was conducted in PubMed, EMBASE, Web of Science, and Scopus databases up to 10/2022. We reconstructed the survival data from published Kaplan-Meier curves on overall survival (OS) meta-analyzed Pembrolizumab+SBRT versus Sorafenib+SBRT versus surgery Pembro. The outcomes of interest were assessed using differences in restricted mean survival time (?RMST) at different time points and Cox regression. Results: Three studies were included in the final analysis (RESORT, RAPPORT and KEYNOTE-564). Overall, 91 patients were included in the meta-analysis. In all the trials, patients had histologically confirmed clear cell RCC (nephrectomy in all the patients out of 3/30 in the RAPPORT) with ECOG=2 and a number of one to five sites of metastatic disease at the time of enrollment. The small number of patients and the incomplete reporting of data did not allow statistical meaningful comparison among the studies. Pembrolizumab+NED obtained the higher OS benefit (Figure 1) (HR: 0.37 compared to Sorafenib+SBRT and 0.33 compared to Pembro+SBRT, all p<0.05), with ?RMST at 24 months of 1.4 months (1.0-1.8) compared with Sorafenib+SBRT and of 1.2 months (0.9-1.3) compared to Pembro+SBRT. Conclusions: Despite lack of baseline differences, lack of power and presence of confounding, this hypothesis generating meta-analysis support the use of the combination of surgery+Pembro for oligometastatic ccRCC. SOURCE OF Funding: None
