Tumor outcomes and thrombus control in renal cell carcinoma (RCC) improved with perioperative treatment that included a targeted agent plus immunotherapy, according to a retrospective analysis presented at the International Kidney Cancer Symposium (IKCS). The study suggests a potential benefit of sequencing immuno-oncology (IO) agents with tyrosine kinase inhibitors (TKIs) in the perioperative setting.
IO/TKI Sequence Enhances Tumor Control
The retrospective review included 55 patients, with 28 receiving IO followed by TKI (IO/TKI) and 27 receiving IO before and after surgery (IO/IO). The objective response rate was 32.1% in the IO/TKI group compared to 22.2% in the IO/IO group. Notably, downstaging of inferior vena cava (IVC) thrombus increased from 37.5% with IO/IO to 45.5% with IO/TKI. Progression-free survival (PFS) also correlated with post-treatment tumor necrosis, which was more pronounced in the IO/TKI arm.
Wadih Issa, MD, of the University of Texas Southwestern Medical Center in Dallas, noted that patients treated with perioperative IO/TKI tended to have more reduction in primary tumors and increased tumor necrosis after treatment. However, immune-related adverse events were significantly more frequent with IO/IO regimens (63% vs 29%, P = 0.01).
CheckMate 214: Long-Term Survival Benefit with Nivolumab/Ipilimumab
An extended follow-up of the CheckMate 214 trial, a phase III study, demonstrated a sustained overall survival (OS) advantage with the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) compared to sunitinib (Sutent) in advanced RCC. At 8 years of follow-up, the median OS was 52.7 months for the nivolumab/ipilimumab arm versus 37.8 months for the sunitinib arm (HR 0.72, 95% CI 0.62-0.83). RCC-specific survival also favored the combination (74 vs 45 months).
Hans J. Hammers, MD, PhD, of the University of Texas Southwestern Medical Center in Dallas, highlighted that responses to nivolumab/ipilimumab were deep and durable, with patients experiencing improved duration of response and more complete responses compared to sunitinib, regardless of disease risk category. The multinational CheckMate 214 trial involved 1,096 patients with newly diagnosed advanced RCC, with the primary endpoint being OS.
Metastasectomy Shows Promise in Select Patients
Data from a prospective study suggest that selective surgery for metastatic RCC may slow disease progression and extend survival. In the study, 73.8% of patients who underwent metastasectomy met the primary outcome of no disease progression at 24 weeks. The 84-patient cohort had a median PFS of 11.6 months and a median OS of 72 months.
Muhammed Onel, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues concluded that surgical intervention in selected patients with metastatic RCC might be associated with delayed disease progression and prolonged OS. The phase II study included patients with metastatic disease scheduled for surgery to achieve a radiographically disease-free state or to manage symptoms and "threatening" lesions.
