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After Second-Line RCC Approvals, Focus Shifts to Frontline

Gina Columbus @ginacolumbusonc
Published: Wednesday, Dec 14, 2016

Chung-Han (Joe) Lee, MD

Chung-Han (Joe) Lee, MD

Three recent drug approvals have shifted the landscape in the second-line setting for renal cell carcinoma (RCC), and researchers are now setting their sights on transforming upfront care, according to Chung-Han (Joe) Lee, MD.

In the second-line setting, the PD-1 inhibitor nivolumab (Opdivo) was approved in November 2015, followed by the respective April 2016 and May 2016 approvals of cabozantinib (Cabometyx) and the combination of lenvatinib (Lenvima) and everolimus (Afinitor), creating promising additions to an already abundant landscape.

Frontline trials with these agents are already creating buzz. For example, in the phase II CABOSUN trial, frontline cabozantinib was found to reduce the risk of progression or death by 34% versus sunitinib (Sutent) for patients with metastatic RCC.

During the 2016 OncLive State of the Science Summit on Genitourinary Cancers, Lee, who is a medical oncologist at Memorial Sloan Kettering Cancer Center, discussed current paradigms and future directions in RCC.

In an interview at the meeting, Lee highlighted recent treatment approvals in RCC, current and emerging treatments and strategies, and the significance of clinical trial enrollment.

OncLive: What was the focus of your RCC discussion at the meeting?

Lee: Today, I briefly went over the new developments within kidney cancer. Over the course of the last 11 years, we have developed approximately 10 new regimens for the treatment of kidney cancer, with 3 of them approved within the last year or so. Then, we talked briefly about adjuvant therapy and some of the questions that have arisen from the studies that have come out, and some of the future directions to take.

Within the last year or so, we had the FDA approval of 3 new regimens for the treatment of kidney cancer: cabozantinib, nivolumab, and our first combination therapy of everolimus and lenvatinib.

How did these recent approvals shift the treatment landscape?

Within the last year, we have really seen, in the second-line setting, a shift in the drugs that are being used at this moment. We have not only shown improvements in overall survival, but also we are starting to look more deeply at some of the resistance mechanisms of some of the first-line therapies.

Where are we at currently with understanding resistance?

There is a lot more research that needs to be done with regard to how we can improve upon the treatments that we have. In addition to the targeted therapies that we currently use, a lot of what we are looking at right now is figuring out how to enhance those treatments in combinations that might be beneficial.

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