Dr Ryan on the Evolution of the Treatment Landscape in RCC

Christopher W. Ryan, MD, professor of medicine, School of Medicine at the Oregon Health & Science University, discusses the evolution of therapeutic treatment approaches across the management treatment landscape of renal cell carcinoma (RCC).

At an OncLive® State of the Science Summit™ on genitourinary cancers, Ryan discussed topline takeaways from the current treatment landscape of RCC. At the event, oncologists discussed first- and second-line therapy options, treatment options for patients with metastatic disease, and adjuvant approaches, Ryan begins. Data with these approaches have indicated that checkpoint inhibitor–based regimens are the standard of care for this patient population in the first-line setting, and has been shown to improve overall survival (OS) for patients with metastatic disease, Ryan expands.

When choosing an immunotherapy-based regimen for a patient with metastatic disease, there are 2 options: a checkpoint inhibitor combination of ipilimumab (Yervoy) plus nivolumab (Opdivo), or a PD-1 inhibitor with a physician’s choice TKI, Ryan explains. From additional clinical trial data and FDA approvals, there has been a documented improved overall survival (OS) benefit with the 4 different combination regimens that are currently commercially available within the RCC space, he adds.

When choosing among the treatments ipilimumab plus nivolumab, pembrolizumab (Keytruda) and axitinib (Inlyta), nivolumab and cabozantinib (Cabometyx), and pembrolizumab and lenvatinib (Lenvima), Ryan continues, it is important to note that all of the combinations have shown improvements in OS. However, it remains important to be cautious about making cross trial comparisons, as there are some differences that emerge when comparing ipilimumab and nivolumab with immunotherapy and TKI combinations, Ryan notes. Additionally, patients who have a response to ipilimumab and nivolumab seem to have durable responses as longer follow-up in the trial becomes available.