Shilpa Gupta, MD, assistant professor of medicine, Hematology/Oncology and Transplantation Division, University of Minnesota, discusses the impact of the phase Ib/II results of pembrolizumab (Keytruda) plus bevacizumab (Avastin) in patients with metastatic renal cell carcinoma (RCC).

Findings from a phase Ib and a phase II study of pembrolizumab with bevacizumab in patients with metastatic RCC showed that the 200 mg dose of pembrolizumab and the 12 mg/kg dose of bevacizumab given every 3 weeks is active and safe. Even though there are currently other combination studies of immunotherapy and VEGF blockade, Gupta says that this combination does not require patients to express PD-L1 ≥ 1%. Gupta says that the results from this study call into question the importance of PD-L1 expression in regard to overall response rate to immunotherapy in RCC.

The rationale for the combination of pembrolizumab and bevacizumab is that the angiogenesis controls the trafficking of cells, and synergy has been demonstrated between anti-VEGF therapies and checkpoint inhibitors in other tumor types. Additionally, it is a tolerable combination for these patients.

Videos

Shilpa Gupta, MD, assistant professor of medicine, Hematology/Oncology and Transplantation Division, University of Minnesota, discusses the impact of the phase Ib/II results of pembrolizumab (Keytruda) plus bevacizumab (Avastin) in patients with metastatic renal cell carcinoma.
 

Dr. Gupta on Impact of Pembrolizumab Plus Bevacizumab Findings in RCC

Shilpa Gupta, MD, assistant professor of medicine, Hematology/Oncology and Transplantation Division, University of Minnesota, discusses the phase Ib/II studies of pembrolizumab (Keytruda) with bevacizumab (Avastin) for the treatment of patients with metastatic renal cell carcinoma (RCC).

Researchers at the University of Minnesota participated in the phase Ib/II trial of pembrolizumab in combination with bevacizumab for patients with metastatic RCC. The trial included patients with refractory, metastatic RCC who had progressed on at least 1 line of therapy. The study aimed to determine the maximum-tolerated dose of the combination. Thirteen patients were enrolled in the study. The combination was very safe and well tolerated, says Gupta.

The phase II portion enrolled 38 patients with treatment-naïve metastatic RCC. These patients received pembrolizumab and bevacizumab at standard doses. The primary endpoint was objective response rate (ORR). The ORR was very impressive at over 60%, surpassing the hypothesized ORR. The combination makes a lot of sense, both scientifically and from a tolerability standpoint, states Gupta.

Shilpa Gupta, MD, assistant professor of medicine, Hematology/Oncology and Transplantation Division, University of Minnesota, discusses the phase Ib/II studies of pembrolizumab with bevacizumab for the treatment of patients with metastatic renal cell carcinoma.

Dr. Gupta on Phase Ib/II Trial of Pembrolizumab With Bevacizumab in RCC

Shilpa Gupta, MD, assistant professor, Hematology Oncology and Transplantation Division, University of Minnesota, discusses the CABOSUN trial investigating cabozantinib (Cabometyx) and sunitinib (Sutent) in patients with renal cell carcinoma (RCC). This was a small study that focused on intermediate- and poor-risk patients, states Gupta.

If sunitinib gets approved in the adjuvant setting, and with the positive findings for immunotherapy, the entire treatment landscape of RCC is currently in flux, Gupta says. There is hope for the combination of TKIs and immunotherapies, explains Gupta, such as the combination of nivolumab, ipilimumab, and cabozantinib.

Shilpa Gupta, MD, assistant professor, Hematology Oncology and Transplantation Division, University of Minnesota, discusses the CABOSUN trial investigating cabozantinib (Cabometyx) and sunitinib (Sutent) in patients with renal cell carcinoma (RCC).

Dr. Gupta on Evolving Treatments for RCC

Shilpa Gupta, MD, assistant professor, Hematology Oncology and Transplantation Division, University of Minnesota, discusses PD-L1 as a biomarker in kidney cancer.

The biomarker question is something that needs to be tackled, says Gupta. Additionally, in kidney cancer, it is not known whether PD-L1 is a predictive biomarker.

Dr. Gupta on PD-L1 as a Biomarker in Kidney Cancer

Shilpa Gupta, MD, assistant professor, Hematology Oncology and Transplantation Division, University of Minnesota, discusses the shifting landscape of kidney cancer.

Dr. Gupta Discusses the Shifting Landscape of Kidney Cancer

Shilpa Gupta, MD, assistant professor, Hematology Oncology and Transplantation Division, University of Minnesota, discusses adjuvant immunotherapy in kidney cancer.

There is a lot of interest in adjuvant therapy in kidney cancer, Gupta says. Trials with immunotherapy are being compared with placebo, but Gupta says that these agents should probably be compared with sunitinib (Sutent), if it gains FDA approval.

Additionally, Gupta says that patients with non-clear cell kidney cancer should be included in these adjuvant trials as well.

Dr. Gupta Discusses Adjuvant Immunotherapy in Kidney Cancer

Shilpa Gupta, MD, assistant professor, Hematology Oncology and Transplantation Division, University of Minnesota, discusses combining VEGF inhibitors with immunotherapy for patients with kidney cancer.

There is currently a trial focused on axitinib (Inlyta) with pembrolizumab (Keytruda) in the first-line setting, explains Gupta.

According to Gupta, since kidney cancer is a VEGF-driven disease, it makes sense to combine the different pathways.

Shilpa Gupta, MD, Cleveland Clinic

Articles