Evolving Treatment Landscape for Patients With Renal Cell Carcinoma

Nicholas J. Vogelzang, MD, the chairman of medical oncology at Comprehensive Cancer Centers and a clinical professor of medicine at University of Nevada, Reno School of Medicine and University of Nevada, Las Vegas School of Medicine, discusses some of the approvals and different regimens seen in today’s renal cell carcinoma (RCC) treatment landscape.

The treatment landscape for RCC has significantly grown over the past decade, specifically in the frontline setting, due to several new combinations becoming available for patients with clear cell histology.

Vogelzang maps out the timeline of the many approvals that have changed the way patients with RCC are treated including nivolumab (Opdivo)/ipilimumab (Yervoy), pembrolizumab (Keytruda), axitinib (Inlyta), and more.

Transcription: 

0:08 | The landscape is confusing to everyone, including treating doctors. The longest approval has been nivolumab/ipilimumab. Those data with Dr. Motzer have been available for about 5 years, so we’ve gotten used to using nivolumab/ipilimumab. That was approved for poor- or intermediate-risk disease and had the best benefit in patients with sarcomatoid histology. It left good-risk patients more or less out of the picture.

0:56 | Then we got approval for pembrolizumab and axitinib, and a lot of doctors liked pembrolizumab/axitinib because it covered good-risk [patients] and we had both a phase 2 and a phase 3 [trial as evidence]. A lot of doctors got comfortable with pembrolizumab and axitinib. Then we had, if you will, the not very positive study of avelumab and axitinib and that did not reach a survival end point compared with sunitinib [Sutent].

1:41 | Then this year, we got the nivolumab/cabozantinib and the CLEAR study of lenvatinib and pembrolizumab. And then lastly, of course, we still have the cabozantinib monotherapy approved as first line for patients.