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Sumanta Kumar Pal, MD, medical oncologist, assistant clinical professor, Department of Medical Oncology and Therapeutics Research, City of Hope, discusses the challenges with sequencing the therapies available for patients with renal cell carcinoma (RCC). Pal shared this insight in an interview during the 2016 OncLive State of the Science Summit on GU Cancer.

During the past several decades, it has become increasingly clear that there is a complicated relationship between a tumor and the patient’s immune system. Although the genetic and epigenetic changes that fuel cancer development create foreign antigens that should trigger an immune response, one of the hallmarks of cancer is its ability to evade this immune recognition.

Although nivolumab has demonstrated a clear survival advantage compared with chemotherapy in patients with progressive non–small cell lung cancer who express PD-L1 in their tumor cells, the same cannot be said for those who are PD-L1–negative.