Efficacy and safety of atezolizumab plus bevacizumab versus sunitinib for metastatic renal cell carcinoma: a systematic review and meta-analysis

Background Inhibitors targeting the programmed death ligand 1 (PD-L1) and angiogenesis inhibitors used for targeted treatments against metastatic renal cell carcinoma (mRCC) have garnered considerable attention in current years. Objective We aim to report the latest and most extensive meta-analysis for providing an evidence-based comparison of the safety and efficacy outcomes of atezolizumab plus bevacizumab versus sunitinib for mRCC. Methods The databases PubMed, Web of Science, and Embase were searched up to March 2023, and studies comparing the clinical outcomes in patients with mRCC who were given atezolizumab plus bevacizumab versus sunitinib were collected. The methodological quality of studies of interest was assessed using the risk of bias assessment tool from Cochrane Collaboration. Results This meta-analysis involved six eligible studies published between 2018 and 2022. Combined analysis indicated that atezolizumab plus bevacizumab compared with sunitinib results in enhanced progression-free survival (PFS), overall survival (OS), overall response rate (ORR), complete response (CR), and partial response (PR), as well as a lower incidence of adverse events (AEs). The time to deterioration (TTD) based on the MD Anderson Symptom Inventory (MDASI) showed improvement. However, TTD based on the Brief Fatigue Inventory (BFI) fatigue severity, the outcome of stable disease, and progressive disease showed no significant differences. Conclusion This study demonstrated that the combined therapy of atezolizumab plus bevacizumab is more effective and safer than sunitinib for mRCC.