In the realm of treating favorable-risk metastatic renal cell carcinoma (mRCC), recent studies have shed light on the efficacy of immune-oncology (IO) combinations compared to tyrosine kinase inhibitors (TKI). The KEYNOTE-426 and CLEAR trials, among others, have provided valuable data on the outcomes of these treatments.
- KEYNOTE-426 and CLEAR trials showed that approximately one-third of patients had favorable risk mRCC, with median follow-ups of 67.2 months and almost 100 months, respectively. The hazard ratio (HR) for overall survival (OS) in these trials indicated varying degrees of efficacy, with CLEAR showing a promising HR of 0.74.
- CheckMate 214 highlighted the long-term benefits of nivolumab plus ipilimumab in favorable-risk patients, suggesting a reconsideration of its use in this population. Despite initial reservations, the data's maturity over time has led to a shift in perspective regarding its application.
- Progression-free survival (PFS) and response rates were significantly better for IO/VEGF-TKI combinations compared to sunitinib across studies, with median PFS and objective response rates (ORR) favoring the IO/VEGF-TKI approach. However, the complete response (CR) rate with nivolumab/ipilimumab was notable, doubling in some instances compared to sunitinib.
- The discussion on sequential IO therapy, particularly following adjuvant pembrolizumab, remains inconclusive. Studies like CONTACT-03 have not shown positive outcomes for sequential IO, indicating the complexity of determining the optimal treatment sequence for mRCC patients.
These findings underscore the evolving landscape of mRCC treatment, emphasizing the importance of long-term data in guiding therapeutic decisions. As research continues, the potential for optimizing IO combinations and sequences offers hope for improved outcomes in favorable-risk mRCC patients.
