Comparison of outcomes of contemporary immune-check point inhibitors combinations in Black patients versus White patients with metastatic renal cell carcinoma (mRCC).

Immune checkpoint inhibitor (ICI)-based combinations, including dual ICI and ICI plus tyrosine kinase inhibitors (TKI), represent the current standard of care for mRCC. However, limited data exists regarding racial differences in treatment outcomes using these combinations. We aimed to compare the effectiveness of ICI combinations in self-identified non-Hispanic Black (Black) versus non-Hispanic White (White) patients with mRCC. Methods: We conducted a retrospective analysis of 600 mRCC patients treated at our institution between 2013 and 2025. Eligible patients had metastatic disease and received ICI combination at any line. Demographics, clinical characteristics, and outcomes were collected via chart review. Overall survival (OS) and time to treatment failure (TTF) were measured from ICI initiation using the Kaplan-Meier method. Univariate and multivariate analyses assessed the association between race and outcomes, adjusting for histology, IMDC risk, and performance status. Results: Among 167 eligible patients, 134 (80%) were White and 33 (20%) were Black, with a median age of 61 years (range 24–84) at the start of ICI. Most patients were male (74%) and had clear-cell histology (81%). ICI combinations were given as first-line therapy in 150 patients (90%), including dual ICI in 67 (41%) and ICI plus TKI in 98 (59%). IMDC risk distribution (good/intermediate/poor) was 22%/52%/26% for White and 10%/52%/39% for Black patients (p = 0.171). The objective response rate (ORR) was higher among White patients (46%) than Black patients (27%) (p = 0.048). Median OS was shorter in Black versus White patients on univariate analysis (HR 1.78 [95% CI 1.09–2.9], p = 0.021), while TTF was similar (HR 0.9 [0.6–1.36], p = 0.63). In multivariate analysis, race was not an independent predictor of OS. Conclusions: In this single-institution study of ICI combinations in mRCC, Black patients exhibited lower response rates and shorter OS compared to White patients. Although the OS difference was not statistically significant after adjusting for multiple strong prognostic factors, these findings suggest potential disparities may still be inherent in ICI combination outcomes between Black and White patients that merit further study in larger, diverse cohorts.