Evolving Practice Patterns for Clear Cell Renal Cell Carcinoma - Episode 16

Incorporating Treatment Advances Into mRCC Management

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Expectations regarding the impact of research in metastatic renal cell carcinoma on the use of immunotherapy and targeted agents in routine clinical practice.

Martin H. Voss, MD: It’s great for us to close with these 2 trials that say so much about what we’re doing in drug development for kidney cancer. The I/O [immuno-oncology]–TKI [tyrosine kinase inhibitor] after I/O–TKI combination data being provocative and promising opens a host of possibilities in what we’ll be studying. The other point you made—thank you for bringing that up—is the adaptive clinical trial designs of sequencing ipilimumab-nivolumab after nivolumab. Although they were disappointing in not demonstrating much bang for our buck by following that strategy, it was so informative and has already made a big impact on choices that folks make in the clinics.

This closes our segment, and I want to thank you all for this rich and very informative discussion, providing your viewpoints and reviewing these data. Before we conclude, I’d like to give each of you an opportunity to share your final thoughts on anything or everything we discussed. We’re going to start with Bob. Please go ahead. Thank you.

Robert S. Alter, MD: I go back to when we gave interferon and IL-2 as an outpatient and high-dose IL-2 as an inpatient. I believe it was in the JCO [Journal of Clinical Oncology] back in January 2006 that Nicholas Vogelzang wrote a very humble article about the embarrassment of riches when we had 2 drugs. We’ve really expanded our horizon. The great thing is that we don’t even know where we can go. We’re still evolving.

I like the studies that are coming on. The belzutifan and lenvatinib study interests me because it takes a TKI and belzutifan vs another TKI. We’re asking the questions about, “Now that we have, let’s play more.” Our patients are definitely going to benefit from this research that’s going on. Kudos to the colleagues who are in the laboratories and the clinicians accessing these clinical trials. Our knowledge comes from our patients, their family, and their support. To our end, I don’t think we should ever stop reaching for the stars.

Martin H. Voss, MD: Thank you, Bob. Dr Powles, what are your final comments here?

Thomas Powles, MD, MBBS, MRCP: In terms of frontline therapy, pick a regimen and use it well. That’s really important. I’m keen that we don’t get too caught up in commercial discussions of different combinations with different attractive components and cross-trial comparisons. There are more similarities than differences. The real skill is using these drugs well, not picking which is the right 1. That’s all I want to say at this point.

Martin H. Voss, MD: Terrific. I appreciate that for this discussion, we’ve not had the emphasis of trying to pick a winner, but we’ve had a pretty comprehensive review of all the data for these regimens. Amishi, do you want to give us some final thoughts for the session?

Amishi Y. Shah, MD: Sure. I completely agree with what Bob and Tom said. It’s an exciting time in the field. We’re so grateful to have so many more options for our patients. There are novel agents yet coming down the pike. We’ll get smarter at combination strategies and sequencing, but it’s important to remember our work isn’t done. We have a lot more to do so we can do the best by our patients and their families, and so we’ll keep at it. Having these open forums for discussion to make sure we’re all learning these data and using them in the right ways is always so helpful.

Martin H. Voss, MD: Thank you so much, Amishi. Last but not least, Dr Srinivas.

Sandy Srinivas, MBBS: It’s incredible to have all these choices—the list of I/Os, the list of TKIs—but I’m really looking forward to the next level of clinical trials where we start picking based on biomarkers, which have been so elusive in RCC [renal cell carcinoma]. Maybe we’re at a point where we can start thinking about angiogenic signatures and immune-mediated T-cell signatures that allow us to pick the drugs we have more wisely for a given patient who can derive the most benefit. My closing thought is going to be our pitch for our patients and providers to enroll in clinical trials and be a big part of it.

Martin H. Voss, MD: Terrific. Thank you all again, and thank you to our viewing audience. We hope you found this OncLive® Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity