Recent Advances in the Treatment of Clear Cell and Non-Clear Cell Renal Cell Carcinoma - Episode 15
Before closing out their discussion on renal cell carcinoma, key opinion leaders highlight efforts to optimize the management of non–clear cell disease with immunotherapy.
Ulka N. Vaishampayan, MBBS: Also to add, what about immune checkpoint therapy in non-clear cell kidney cancer? Because that’s one point we didn’t touch on. We talked about cabozantinib [Cabometyx] being as established as the frontline standard now for future comparisons and studies, and the role of immune checkpoint therapy. There were 2 different phase 2 trials, one with cabozantinib and nivolumab [Opdivo] that reported promising response rates of 60% or so, and similarly with lenvatinib [Lenvima] and pembrolizumab [Keytruda], which reported about 70% response rates in non-clear cell histology kidney cancer. Now within non-clear cell there are different magnitude of responses because papillary tends to respond better as compared to some of the other chromophobe, etc, which maybe mTOR inhibitors would make more sense in those settings. There is a SWOG [Southwest Oncology Group] study, SWOG 2200 that will look at cabozantinib plus or minus immune checkpoint inhibitor. That will be a randomized trial that has recently activated, and will hopefully help us establish the frontline IO [immuno-oncology]-based combination therapy advantage, or not of that combination in papillary kidney cancer.
Moshe Ornstein, MD: I completely agree. As monotherapy has activity, there’s been data that the TKIs [tyrosine kinase inhibitors] have activity. The question of whether to give them together is now, to some extent, answered because we have these trials of lenvatinib, pembrolizumab, and cabo [cabozantinib]/nivo [nivolumab]. For somebody who’s considering giving that combination, there’s data to support it. It will be helpful to have the randomized trial of cabozantinib, now the standard, in papillary RCC [renal cell carcinoma] versus cabozantinib with checkpoint blockade to establish the benefit of adding a checkpoint inhibitor in non-clear cell, specifically in papillary RCC.
Ulka N. Vaishampayan, MBBS: Because the question comes up, do you need to do combination upfront, or can you get to the same place by doing sequential therapy? Toxicity wise, doing sequential single agent is much easier to take than doing combination.
Transcript edited for clarity.