Thomas Powles, MBBS
The treatment of patients with kidney cancer will differ greatly in the next decade because of changes in the landscape that occurred in 2017, according to Thomas Powles MBBS, MRCP, MD.
, Powles, a clinical professor of genitourinary oncology, Barts Cancer Institute in London, United Kingdom, discussed the findings from the CheckMate-214 trial, as well as continuing studies in immunotherapy and targeted therapy in kidney cancer, and how this new data might affect the treatment of kidney cancer going forward.
OncLive: Please discuss some of the recent advances in the treatment of patients with kidney cancer.
There has been a change in kidney cancer over the last year. It has been an enormous change; in fact, things will never be the same again. The change has been the essential replacement of frontline VEGF-targeted therapy with combination immunotherapy. That change happened because of a trial called CheckMate-214, which combined ipilimumab and nivolumab. It showed that those 2 drugs in patients with intermediate- or poor-risk disease outperformed sunitinib in terms of response rate and, importantly, overall survival [OS].
There are some complicating issues in the data, as you can imagine. There is a group of good-risk patients, who obviously have good prognostic factors, performance status, and blood parameters. In their premature analysis, this group of patients didn't seem to do better with immunotherapy than sunitinib. In my opinion, that data are immature, and we will have to see how that pans out. But certainly VEGF-targeted therapy for that group of good-risk patients is still a viable option. Although, I would argue that you could also give immunotherapy to that group.
What questions remain about the future of immunotherapy in kidney cancer?
During this period of transition in kidney cancer—away from oral VEGF-targeted therapies to immune therapies—there is a question of, “What will the landscape look like?” Is that going to be immune combination therapy with ipilimumab and nivolumab? Is it going to be immune and VEGF-targeted therapies such as atezolizumab and bevacizumab, or pembrolizumab [Keytruda] and axitinib [Inlyta]?
I am really trying to pick through some of the issues that we are going to face over the next year or 2. Which drugs should we use? Can we select patients for particular therapies? How is the community going to deal with the new toxicity profiles of drugs that we haven't used widely before? How will we integrate these options into clinical practice? What I mean by that is, if we are giving sunitinib or pazopanib (Votrient) as standard of care, and then we give ipilimumab and nivolumab in 6 months, what do we do when the immunotherapy fails? Do we give the same drugs as we gave originally? Should we move to second-line therapy with axitinib and cabozantinib?
... to read the full story