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Choueiri Reflects on Recent RCC Advances

Angelica Welch
Published: Thursday, Jul 26, 2018

Toni K. Choueiri, MD
Toni K. Choueiri, MD
The 2018 ASCO Annual Meeting included a number of clinical highlights in renal cell carcinoma (RCC), according to Toni K. Choueiri, MD. On the heels of multiple FDA approvals throughout the latter half of 2017 and the beginning of 2018, the field continues to rapidly shift.

Choueiri, director of the Kidney Cancer Center at Dana-Farber Cancer Institute, recapped some of the most significant data presented thus far in 2018 for the treatment of patients with RCC.

OncLive: Can you reflect on the CARMENA trial that was presented at the 2018 ASCO Annual Meeting?

Choueiri: It was a big conference for kidney cancer; we had a presentation that made it to the plenary session, [which was] CARMENA. This study asked the question of VEGF-targeted therapy in the modern setting, namely sunitinib, and whether taking the kidney out in metastatic RCC by cytoreductive nephrectomy makes sense. What was presented in the past in the cytokine era, as well as the many retrospective studies, was that cytoreductive nephrectomy helps.

We will still look at CARMENA in great detail for the months and years to come. Again, patients with poor-risk RCC should not even be considered. The question is, “Should we consider cytoreductive nephrectomy at baseline or later on in patients with a large primary tumor with great performance status and very limited disease burden outside the kidney?” That is an open question and an important study. 

What other oral presentations took place at this year’s meeting?

One was a study of pembrolizumab (Keytruda), another was a study of the combination of atezolizumab and bevacizumab, and then there was a study of sorafenib. They all happen to be in untreated advanced clear cell RCC.

Pembrolizumab was tested and showed a response rate of 38% in this untreated population. There were usual single-agent immune-related adverse events. In PD-L1–positive patients, the response rate was 50%, which begs the question, “Can this agent be used alone or should we use it in combination?” We do not have a lot of data in this context with single-agent PD-1/PD-L1 inhibitors. We do have data with pembrolizumab and atezolizumab and very little data with nivolumab (Opdivo). The story is evolving, and pembrolizumab is being tested in first-line therapy with axitinib (Inlyta) in combination as well as in the adjuvant setting.

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