Primary Progressive Disease Rate Supports IO/TKI Use in Frontline mRCC

EP: 1.Reviewing the Choice of First-Line Combinations for Clear Cell RCC and Other Histologies

EP: 2.POLL: What Frontline Treatment Would You Choose for Favorable- and Intermediate-Risk RCC?

EP: 3.Choosing Frontline RCC Therapy After Detecting Metastases in Patient Under Observation

EP: 4.Comparing Physician Experience With Trial Data for Frontline RCC Regimens

EP: 5.Reviewing Updated Survival and Subgroup Data of CheckMate9ER for RCC

EP: 6.Physicians Discuss Potential of Frontline Triplet Regimens for RCC

EP: 7.Opinions on the Optimal Role of Ipilimumab/Nivolumab in RCC

EP: 8.Selecting IO/TKI Therapy for mRCC Based on Patient Profile

EP: 9.Real-World Factors Influence Choice of IO/TKI Regimen for mRCC

EP: 10.Risk Group Data Raises Questions on Choice of Frontline Therapy in RCC

EP: 11.Physicians Discuss Counseling on Immunotherapy Discontinuation in RCC

EP: 12.Updated Data Supports Use of Nivolumab + Cabozantinib in Advanced ccRCC

EP: 13.Nivolumab plus Cabozantinib Continues to Show Benefit in Advanced RCC

EP: 14.Risk Stratification Influences Approach in Frontline Advanced RCC Care

EP: 15.Treatment Selection and Dosing Strategies Based on Trial Data in RCC

EP: 16.Updated Data Shows Durable Efficacy of Cabozantinib/Nivolumab in mRCC

EP: 17.Management of Serious Toxicities with Cabozantinib/Nivolumab in mRCC

EP: 18.Risk Stratification Influences Choice of Frontline IO/TKI Regimen in mRCC

EP: 19.Evolving Evidence Guides Treatment Selection for Favorable-Risk mRCC

EP: 20.Deciding Factors for Front-Line Therapy in Metastatic RCC

EP: 21.Comparing Choices for IO/TKI Combinations in Advanced RCC

EP: 22.Comparing Long-Term Data for IO/IO and IO/TKI in Favorable-Risk mRCC

EP: 23.Frontline Cabo/Nivo in RCC Supported by Risk Status, Metastasis Analyses

EP: 24.GU Oncology Peers Explore Early Therapy Approaches in Low-Volume mRCC

EP: 25.Long-Term Data Prompt Shifting Approaches to Frontline RCC Therapy

EP: 26.Participants Discuss Differences in Treatment in First-Line mRCC

EP: 27.Considering How Favorable Risk Affects Treatment in ccRCC

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EP: 28.Primary Progressive Disease Rate Supports IO/TKI Use in Frontline mRCC

Alan Tan, MD, assistant professor of Medicine in the division of hematology and oncology at Vanderbilt University Medical Center, discusses factors influencing the choice of IO (immunotherapy) plus tyrosine kinase inhibitor (TKI) vs dual IO in patients with metastatic renal cell carcinoma (mRCC).

A major downside of dual IO in this setting is that the rate of primary progressive disease (PD) in the CheckMate 214 trial (NCT02231749) of nivolumab (Opdivo) plus ipilimumab (Yervoy) was 18% compared with lower PD rates in the CheckMate 9ER trial of cabozantinib (Cabometyx) plus nivolumab and the CLEAR trial of lenvatinib (Lenvima) plus pembrolizumab (Keytruda). In patients who need a rapid response, such as those with bulky disease or high-risk symptoms, IO/TKI might be preferred, Tan said.

Tan added that the IO/TKI regimens may be more similar than different and oncologists who have more expertise in one can serve their patients in managing it.

In a Case-Based Roundtable event he moderated, Tan and other oncologists generally agreed that a major reason they still consider dual IO instead is a better chance at durable remission, because quality of life and indefinite time off treatment are important to patients.

TRANSCRIPTION

0:10 | The downside from IO/IO is that you have primary progressive disease rate of 18% and then you have much lower primary progressive disease rate with IO/TKI, specifically, you know, in the CheckMate 9ER, you have primary PD rate of anywhere from 5% to 7% and then same with the CLEAR trial as well. When you need patients to have a rapid response—we talked about scenarios of when patients would need more rapid debulking—when they're higher in symptom scores, and things like pleural effusion, ascites, hypercalcemia, we touched it based on a lot of these things.

0:57 | But ultimately, between the IO/TKI combinations, I think there's more similarities than differences here. I think we're achieving relatively similar comparable overall response rates, and we're also showing that PFS and OS are probably very comparable as well. I think amongst the 3 IO/TKI trials, there may be some differences in the IMDC distributions. The CLEAR trial had a little bit more [favorable] risk and less poor risk.

1:32 | So I think we all take into consideration all of these factors when we interpret the data, but ultimately you can even apply the principle with IO/TKI as, choose one and do it well. Just become an expert at your favorite one, and I think you're not really doing the patient that you're treating a disservice with that.

But ultimately…most of us at least agree that trying to give the patient that one opportunity to have that durable, complete response or partial response that lasts a long time or maybe indefinitely, is really important, because what do patients really value? That's the chance for a cure, a chance to actually have a good quality of life off treatment for extended period of time.