Dr. Choueiri on Frontline Combination Therapies in mRCC

Toni Choueiri, MD, director, Lank Center for Genitourinary Oncology, director, Kidney Cancer Center, senior physician, Dana-Farber Cancer Institute, and Jerome and Nancy Kohlberg Chair and professor of medicine, Harvard Medical School, discusses the frontline combination therapies that are available for the treatment of patients with metastatic renal cell carcinoma (mRCC).

Careful consideration of which frontline combination therapy to pursue is crucial now that there are several, says Choueiri. In addition to pembrolizumab (Keytruda) and axitinib (Inlyta), there is axitinib and avelumab (Bavencio), nivolumab (Opdivo) and ipilimumab (Yervoy), and potentially cabozantinib (Cabometyx) and nivolumab, pending positive trial data.

At this point, there is a lot of familiarity with pembrolizumab, adds Choueiri; the dosing schedule is every 3 weeks, which is easier on patients and providers. Notably, in the phase III KEYNOTE-426 trial, which looked at pembrolizumab plus axitinib, there was an overall survival benefit with the combination. Conversely, there are no data to suggest a survival benefit with avelumab plus axitinib, despite the fact that the response rates and progression-free survival are very similar, says Choueiri. In addition, the combination of nivolumab and ipilimumab is restricted to use in intermediate- and poor-risk patients, but it has induced the highest complete response rates out of these combinations. These are very durable responses which may result in cure, thereby making it a very attractive regimen.