Daniel J. George, MD
Renal cell carcinoma (RCC) is a field that is shifting dramatically in the metastatic setting, but progress has been slower for patients with high-risk stage III disease, said Daniel J. George, MD.
on Genitourinary Cancers, George, professor of Medicine and Surgery, member, Duke Cancer Institute, discussed the status of treatment for patients with high-risk stage III RCC, as well as the role of sunitinib (Sutent) and checkpoint inhibitors in the RCC paradigm.
OncLive®: What are the recent data seen with TKIs in the landscape?
: RCC is a field that is dramatically changing—we are making progress in advanced metastatic disease. However, for patients with stage III disease who are high risk for disease recurrence after surgery, there really have not been any breakthroughs until recently. For the most part, that has been an unmet need. We have done some clinical trials looking at TKIs in that setting.
Therefore, dose matters when it comes to the adjuvant setting. The struggle is that dose also results in toxicity. How to balance that is key. Identifying patients who have fully recovered with [an ECOG performance status of] 0 following surgery is important, and counseling patients around the tolerance and being proactive with dose interruptions, rather that dose reductions, is very important. However, if you do that, there is definitely a patient population out there that can benefit and tolerate these drugs in this setting.
Could you expand on the evolution of sunitinib’s role over the last few years?
Sunitinib has been in the field for over 10 years. It was approved by the FDA in 2006 based on some robust progression-free survival (PFS) data versus interferon in frontline metastatic RCC. It has been the mainstay of our treatment for metastatic RCC since then. However, in the last couple of years, we have begun to see trials reporting out comparing other agents with sunitinib, particularly in patients with intermediate- and poor-risk disease. In those settings, nivolumab (Opdivo) and ipilimumab (Yervoy) showed a statistically significant improvement in overall survival in those patients treated with immunotherapy versus sunitinib.
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