Dr. Figlin on Considerations for Combining TKIs and Immunotherapy in RCC

Robert A. Figlin, MD
Published: Thursday, Jan 10, 2019



Robert A. Figlin, MD, director, Division of Hematology/Oncology, Steven Spielberg Professor of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, discusses considerations when combining TKIs and immunotherapy agents in the management of advanced renal cell carcinoma (RCC).

Since the FDA approved the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for patients with advanced intermediate- and poor-risk RCC, other immunotherapy regimens are moving through the pipeline with encouraging activity. Oncologists in general are becoming more comfortable treating patients with immuno-oncology agents as monotherapy or in combination, Figlin says.

With the proof of concept data for immunotherapy in this paradigm, there has been significant interest in exploring other combinations—specifically with TKIs. The combination of TKIs with checkpoint inhibitors does not result in a unique toxicity profile that physicians are not already aware of. An important factor will be choosing an endpoint to determine the necessary treatment strategy: Is the goal objective response rate, progression-free survival, overall survival, or adverse event profile?

Conversations that physicians are having with their patients are evolving. Patients now understand these therapies not only offer a duration of treatment and maintenance of quality of life, but the possibility that there may come a time in the future that their tumor may be reduced enough to allow for discontinuation of treatment.
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Robert A. Figlin, MD, director, Division of Hematology/Oncology, Steven Spielberg Professor of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, discusses considerations when combining TKIs and immunotherapy agents in the management of advanced renal cell carcinoma (RCC).

Since the FDA approved the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for patients with advanced intermediate- and poor-risk RCC, other immunotherapy regimens are moving through the pipeline with encouraging activity. Oncologists in general are becoming more comfortable treating patients with immuno-oncology agents as monotherapy or in combination, Figlin says.

With the proof of concept data for immunotherapy in this paradigm, there has been significant interest in exploring other combinations—specifically with TKIs. The combination of TKIs with checkpoint inhibitors does not result in a unique toxicity profile that physicians are not already aware of. An important factor will be choosing an endpoint to determine the necessary treatment strategy: Is the goal objective response rate, progression-free survival, overall survival, or adverse event profile?

Conversations that physicians are having with their patients are evolving. Patients now understand these therapies not only offer a duration of treatment and maintenance of quality of life, but the possibility that there may come a time in the future that their tumor may be reduced enough to allow for discontinuation of treatment.



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