Frontline Combination Approaches for Metastatic RCC

Toni Choueiri, MD: For the past year or two and most recently at the Genitourinary Cancers Symposium, we are having an explosion of first-line options in this disease [metastatic renal cell carcinoma]. It is something quite refreshing. The combination of nivolumab and ipilimumab is the only IO [immunotherapy]/IO combination. After multiple cutoffs of the data and follow-up to 4 years, we’re seeing a hazard ratio for survival of 0.6, so stable. This is an option that is illustrated by the NCCN [National Comprehensive Cancer Network] guidelines as a first-line option. Now we are seeing more options coming along. The combination of pembrolizumab and axitinib does have an overall survival after several data cuts, and it is also a preferred regimen, both in [patients with ] favorable and intermediate-poor risk.

The nivolumab and ipilimumab combination is in poor and intermediate only.More recently the option of cabozantinib and nivolumab is also a preferred first-line option in both the favorable and the poor and intermediate, based on the CheckMate 9ER trial. This regimen was approved in January of 2021. There are other recommended regimens, some of them are combinations, some are as a single agent, but these are the most important frontline ones illustrated by the NCCN guidelines.

Transcript edited for clarity.