Inside the Clinic: Optimizing Outcomes in Patients With RCC: Translating Evidence to Clinical Practice - Episode 11

Non–Clear Cell RCC: Clinical Rationale Behind Therapy

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A brief review of the clinical rationale behind therapeutic regimens used for patients with non-clear cell carcinoma.


Robert J. Motzer, MD: Chung, you’ve led our efforts in therapeutics for non–clear cell RCC [renal cell carcinoma]. Recently you presented these exciting data for cabozantinib plus nivolumab, which this patient is being treated with. How do you see this entity of non–clear cell in terms of different groups of patients or histologies. What’s been your experience with this cabozantinib-nivolumab regimen?

Chung-Han Lee, MD:Historically speaking, this non–clear cell entity has always been this grab bag of histologies. Clear cell kidney cancer is the most common histology, and non–clear cell just happens to be everything else. From clinical trial eligibilities, from our standpoint, most clinical trials that have been done have focused on clear cell. The regimens that are available for clear cell have activity within the non–clear cell cohorts. However, those efficacy rates tend to be lower. We led a study at Memorial [Sloan Kettering Cancer Center] looking at the role of cabozantinib plus nivolumab, to estimate the efficacy of this regimen. It made a lot of sense from a clinical aspect because cabozantinib has demonstrated a lot of activity within the papillary kidney cancer group, which is the most common of the non–clear cell cohort, and cabozantinib-nivolumab also shows high levels of activity within clear cell.

When we decided to do this study within non–clear cell kidney cancer, we observed a fairly high objective response rate: about 48% over a patient population of about 40 people. This led to the protocol being subsequently expanded to 80 so that we can get a better estimate of this regimen. There’s a lot of very encouraging news for non–clear cell. We need to make additional efforts in better tailoring and stratifying based off the various histologies within that non–clear cell cohort, so we can help this very unmet population.

Transcript edited for clarity.