Dr. Choueiri Discusses Immunotherapy in RCC

Toni Choueiri, MD, director, Lank Center for Genitourinary Oncology, director, Kidney Cancer Center, Jerome and Nancy Kohlberg Associate Professor of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, discusses the use of immunotherapy as treatment for patients with renal cell carcinoma (RCC).

RCC has traditionally been managed with cytokines, VEGF TKIs, and mTOR inhibitors, but immunotherapy has recently made a comeback in the form of checkpoint inhibitors, Choueiri says. The first PD-1 inhibitor to garner FDA approval in this space was nivolumab (Opdivo) for use as a single agent in the second-line treatment of patients who progress on sunitinib (Sutent). This decision was based on positive data from the pivotal CheckMate-025 study, in which nivolumab demonstrated an overall survival (OS) benefit.

Based on more recent data, immunotherapy may now move into the frontline in the form of a combination therapy comprised of nivolumab and ipilimumab (Yervoy), Choueiri says. The combination showed an OS advantage over sunitinib, which has served as the frontline standard for over a decade.

With the proof of concept for checkpoint inhibitors in this space, Choueiri notes, there is interest to explore these agents in combination with VEGF TKIs. Phase I data has shown impressive response rates and tolerability with this approach, and phase III studies are ongoing. Despite the positive data that has read out in recent months, he notes, the landscape for RCC remains complex.