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Renal Cell Carcinoma · Medical Oncology · First-line Metastatic

IMmotion151

In previously untreated metastatic RCC, does atezolizumab plus bevacizumab improve outcomes compared with sunitinib?

Population915 patients; 362 (40%) had PD-L1-positive disease.InterventionAtezolizumab 1200 mg IV + bevacizumab 15 mg/kg IV every 3 weeks.ComparatorSunitinib 50 mg orally daily, 4 weeks on/2 weeks off.Primary clinical outcomePFS in PD-L1-positive disease; OS in ITT population.

Absolute Effect

In PD-L1-positive disease, 12-month PFS was 49% vs 38%, an absolute improvement of 11 points (NNT ≈ 10). Median PFS was 11.2 vs 7.7 months (HR 0.74).

Final OS did not show a survival advantage. Grade 3–4 treatment-related adverse events were 40% vs 54% in the primary analysis.

Clinical interpretation

IMmotion151 met its PD-L1-positive PFS endpoint but did not establish an OS advantage. The trial is historically important because it demonstrated biomarker-defined PFS activity of VEGF plus PD-L1 blockade, while later treatment landscapes shifted toward other immune-combination regimens.

Source

Rini BI, et al. Lancet. 2019;393:2404–2415.

Current-practice context · reviewed 14 October 2026

IMmotion151 improved PFS in the PD-L1-positive subgroup but did not demonstrate a final overall-survival advantage in the intention-to-treat population. Atezolizumab–bevacizumab is not a universal first-line default in contemporary metastatic RCC; use current IO–TKI/dual-ICI evidence, patient comorbidity, contraindications and local approvals to choose among options.

IMmotion151 primary/long-term source ↗ · Current guideline guidance ↗