The expert from the University of California San Diego discusses the importance of the findings presented at the 2020 ASCO Virtual Scientific Program
Nivolumab (Opdivo) plus ipilumumab (Yervoy) is the established first-line treatment for advanced renal cell carcinoma (RCC), but optimal duration of nivolumab and sequencing for ipilumumab remains unclear. Results from the response-based phase II OMNIVORE study, presented during the 2020 ASCO Virtual Scientific Program, demonstrated that delayed treatment with ipilumumab is insufficient to achieve a response in patients with RCC.
In an interview with CancerNetwork, Rana R. McKay, MD of the University of California San Diego discusses the impact of these findings, and what it may mean for practicing clinicians.
So, with regards to the impact of this study, you know, many individuals, out in clinical practice in the community are faced with patients before them and are constantly asking the question of balancing risk and toxicity. Does everybody need to get nivolumab/ipilumumab, there's toxicity that's associated with nivolumab/ipilumumab, there's this fear, potentially that may be associated with use of that combination, and sometimes there may be kind of off label practices. Well, maybe I'll just start with a nivolumab, and I'll add ipilumumab in if I need it. And I think, you know, we decided to actually answer that question in the context of a very cleanly designed trial. And really what we demonstrated with this, is this approach is really not the best approach for patients. Patients actually need upfront combination nivolumab and ipilumumab when that combo is being used. And so, this adaptive design of starting with one than adding the other and trying to salvage is really not the right strategy. So, I really think it actually helps clinicians say hey, you know, there's actually, you know, data out there to say that maybe this isn't the best approach. Unless I have a reason to really not add, to not use the ipilumumab, you know [if] there's patient comorbidities or toxicities, or maybe they have somebody with an autoimmune disease, I really should try to use what is the recommended standard as opposed to trying to come up with something that isn't the standard.