Dr Ornstein weighs in on interpreting quality of life data from important RCC trials to help with treatment decision-making.
Tian Zhang, MD: I’d love to move on to quality-of-life data. Dr Ornstein, could you take us through some of the quality-of-life data we’ve seen at GU ASCO [American Society of Clinical Oncology Genitourinary Cancers Symposium]?
Moshe C. Ornstein, MD, MA: Quality of life is critical for patients with metastatic RCC [renal cell carcinoma], especially considering that most of these patients are going to be on therapy for long periods of time. When we move from single-agent therapy, like sunitinib and pazopanib, to combination therapy, 1 fear is that if you’re going from 1 to 2 in terms of therapies that you might be doubling toxicity and negatively impacting quality of life.
Broadly, it’s important to note that quality-of-life data across different trials is difficult to interpret. There are sometimes different surveys, and surveys can be taken at different time points. There’s a lot of nuance that goes into health-related quality of life. But we can say fairly definitively that across these 4 combinations—ipilimumab-nivolumab, axitinib-pembrolizumab, cabozantinib-nivolumab, and lenvatinib-pembrolizumab—the quality of life with the combination is no worse than it is with sunitinib monotherapy. That’s very reassuring.
At GU ASCO 2022, there was an update to the quality-of-life [data] for cabozantinib-nivolumab and ipilimumab-nivolumab. These are the 2 that demonstrated that the quality of life was superior to sunitinib. Thankfully, with the updated data we see that quality of life in terms of superiority to sunitinib is sustained with longer follow-up. When it comes to lenvatinib-pembrolizumab and axitinib-pembrolizumab, the combination in terms of quality of life does not appear to be worse than sunitinib, but there’s no clear signal that it’s better across the different surveys. If I’m summarizing this for practicing physicians, quality of life for combinations is no worse. But in updated data that we just saw for ipilimumab-nivolumab and cabozantinib-nivolumab, it’s superior than sunitinib.
Tian Zhang, MD: Wonderful. Thanks so much for that succinct summary of all the quality-of-life data. A lot of us grapple with it when we’re talking about it with our patients.
This transcript has been edited for clarity.