ASCO GU: Highlights on Renal Cell Cancer: IMmotion151 and Other Combination Studies

Speaker: Bernard Escudier

Reporting from ASCO GU 2018, Bernard Escudier states that the results from studies presented are likely to be practice changing for the treatment of patients with renal cell cancer (RCC), regarding first-line options and patients' selection.

In untreated metastatic RCC, the IMmotion151 trial showed a 3 months increase in progression-free survival (PFS) with atezolizumab/bevacizumab versus sunitinib in PD-L1 positive patients according to the investigator's analysis. In this trial, the independent review analysis of data didn't confirm the statistically significant difference in PFS, which is important as every drug approval in RCC has been based on results from independent reviews.

In this study, there is a positive trend in term of overall survival and if confirmed, the protocol should become a standard of care in RCC.

The update on the phase Ib study on safety and efficacy of axitinib combined with pembrolizumab in advanced RCC showed a very impressive response rate of 73%, a complete remission rate of 7% with a relatively good safety profile.

Results from a phase Ib/II French study with nivolumab combined with tivozanib also showed a very high response rate of 64%.

In conclusion, Bernard Escudier says that after Nivo-Ipi combination presented at ESMO 2017, with combinations of VGFR and PD-1 or PD-L1 blocking agents presented at ASCO GU 2018, we are certainly moving from monotherapy to combination RCC treatment.

Next question to address will be patients selection to know which profile will benefit the most from which combination. We had some indications that PD-L1 should be tested and in case of positive status patients may benefit more from the Nivo-Ipi combination, and if PD-L1 negative may have a better response with the combination of IO plus VEGF targeted agents.

Sunitinib and pazopanib which have been the reference in the last 10 years will most likely become later line treatment.