David F. McDermott, MD, discusses the use of PD-1 inhibitors in combination with VEGF inhibitors and CTLA-4 inhibitors in metastatic renal cell carcinoma.
David F. McDermott, MD, director of the Biologic Therapy and Cutaneous Oncology Programs at Beth Israel Deaconess Medical Center, professor of medicine, Harvard Medical School, discusses the use of PD-1 inhibitors in combination with VEGF inhibitors and CTLA-4 inhibitors in metastatic renal cell carcinoma (mRCC).
These combination approaches have replaced single-agent VEGF inhibition in the frontline setting, says McDermott. Single-agent VEGF inhibition is reserved for patients who cannot receive a PD-1 inhibitor, such as those who have an active autoimmune disease.
The question of whether to use a PD-1 and VEGF inhibitor or a PD-1 and CTLA-4 inhibitor first remains under investigation, says McDermott. It appears that VEGF inhibitors can salvage patients who fail PD-1/CTLA-4; however, more research is needed to determine the optimal salvage treatment for those who progress on PD-1/VEGF.
Notably, PD-1 inhibitors could show promise in the adjuvant setting, and many ongoing clinical trials are exploring that notion further, concludes McDermott.