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Expert Shares Upfront Sequencing Strategies in mRCC

Gina Columbus
Published: Thursday, Jul 05, 2018

Sumanta Kumar Pal, MD
Sumanta Kumar Pal, MD
Even with 2 recent FDA approvals in the frontline setting for patients with metastatic renal cell carcinoma (mRCC), an ongoing clinical trial exploring combination therapy with a multikinase inhibitor and an anti–PD-L1 agent could be yet another path forward, according to Sumanta Kumar Pal, MD.

In April 2018, the FDA approved the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) as a frontline therapy for intermediate- and poor-risk patients with RCC, based on phase III data from the CheckMate-214 trial. This decision followed the December 2017 approval of frontline cabozantinib (Cabometyx) in RCC. The approval of the multikinase inhibitor was based on a meaningful improvement in progression-free survival versus sunitinib (Sutent) in the phase II CABOSUN trial.

Now, an open-label, multicenter, phase Ib study (NCT03170960) is looking at the combination of atezolizumab (Tecentriq) with cabozantinib across several tumor types, including in advanced RCC as a frontline treatment. Investigators on the trial, which will have a dose-escalation followed by a dose-expansion stage, will evaluate the safety, efficacy, and pharmacokinetics of the regimen.

In an interview during the 2018 OncLive® State of the Science Summit™ on Genitourinary Cancers, Pal, a medical oncologist at City of Hope, shed light on the latest frontline therapeutic options for patients with mRCC and other advancements on the horizon.

OncLive: What did you highlight during your discussion on first-line treatment in kidney cancer?

Pal: A lot of discussion hinged on some of the newer data with bevacizumab (Avastin )and atezolizumab in the IMmotion151 trial. We are really seeing some outstanding efficacy with this combination of agents—supporting this premise of using a VEGF inhibitor with an immuno-oncology agent. We discussed the evolving data sets that combine VEGF inhibitors and immunotherapy-based agents, and I also alluded to some of the trials that I’m really excited about. 

For instance, I’m chairing a trial looking at cabozantinib with atezolizumab with Dr Neeraj Agarwal, and that is one that folks should consider enrolling on across a wide spectrum of GU cancers, in fact. 

Can you discuss the frontline approval of nivolumab and ipilimumab? Is this a regimen you’re already using in patients?

I’ve been involved with the development of nivolumab/ipilimumab in RCC from the phase I clinical trial onward. I was on the CheckMate-016 study, which was followed very quickly by the big phase III CheckMate-214. That study showed a very convincing and compelling improvement in overall survival with nivolumab and ipilimumab relative to sunitinib. Those data were very impressive.




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