TKI-Immunotherapy Combinations Push the Envelope in Frontline RCC

Meir Rinde
Published: Friday, Apr 12, 2019
Eric Jonasch, MD

Eric Jonasch, MD

Convincing data have made the case for the use of immunotherapy in the frontline for advanced renal cell carcinoma (RCC), ushering in a second revolution in slightly more than a decade. In 2007, the anti-VEGF tyrosine kinase inhibitor (TKI) sunitinib (Sutent) elbowed aside interferon alfa in advanced RCC. Now, TKI monotherapy is on the verge of being displaced by immunotherapy combinations.

The National Comprehensive Cancer Network (NCCN) is contemplating a frontline treatment guideline change to include pembrolizumab (Keytruda) plus axitinib (Inlyta), as well as avelumab (Bavencio) plus axitinib, as results of recently completed clinical trials are considered by the FDA, according to Eric Jonasch, MD, vice chair of the NCCN Clinical Practice Guidelines in Oncology Panel for Kidney Cancer.1

“We have a number of potential approvals over the next 6 months…making this algorithm quite dynamic and quite interesting,” Jonasch said during a presentation at the 2019 NCCN Annual Conference, held March 21 to 23 in Orlando, Florida.1

Recent results show significantly longer overall survival (OS) with pembrolizumab and axitinib compared with sunitinib, and with FDA approval of the combination anticipated, oncologists are beginning to consider when to give it to patients and when to use ipilimumab (Yervoy) plus nivolumab (Opdivo), which became the standard frontline treatment for intermediate- and poor-risk patients just last year. They are also looking forward to seeing more data on novel combinations and agents that may advance progress in making RCC a chronic or in some cases curable disease.

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