Bradley McGregor, MD

Bradley McGregor, MD, physician, Genitourinary Oncology program, Dana-Farber Cancer Institute, and instructor of medicine, Harvard Medical School, discusses whether patients with renal cell carcinoma (RCC) need frontline combination therapy.

Frontline combination therapies have taken hold of the RCC landscape, but physicians have yet to determine whether everyone should receive a frontline combination therapy, says McGregor. In the CheckMate-214 trial, the combination of ipilimumab (Yervoy) and nivolumab (Opdivo) was compared with sunitinib (Sutent) in the frontline setting and showed an improvement in overall survival. However, patients with good-risk disease demonstrated a higher rate of progression-free survival with sunitinib than with the combination.

Additionally, patients in the trial were accrued prior to the FDA’s approval of the combination in the United States. Less than 30% of patients who received sunitinib crossed over to receive immunotherapy in the trial. Researchers did not allow crossover until the data were reported, which was in 2016. Therefore, it is unknown if patients who receive frontline sunitinib and second-line immunotherapy experience the same magnitude of benefit, explains McGregor.

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Dr. McGregor on Whether Patients Need Frontline Combinations in RCC

Bradley McGregor, MD, physician, Genitourinary Oncology program, Dana-Farber Cancer Institute, instructor of medicine, Harvard Medical School, compares recent data with combination therapy in renal cell carcinoma (RCC).

Results from the phase III CheckMate-214 trial and the IMmotion151 trial have proven the success of combination therapy in patients with advanced RCC.

In April 2018, the FDA approved the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) as a frontline treatment for intermediate- and poor-risk patients with advanced RCC. This approval was based off findings from the phase III CheckMate-214 study, which showed a 32% reduction in the risk of death with the combination compared to sunitinib (Sutent). McGregor says that the most appealing data out of this trial were the complete response (CR) rates, specifically in the PD-L1—positive subgroup, which was 16%. The CR rate for the PD-L1–negative group was comparable with what is seen with interleukin-2, he added.

Findings from the IMmotion151 trial showed that the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) reduced the risk of death by 26% compared with sunitinib in patients with untreated PD-L1—positive metastatic RCC. McGregor says that the most appealing thing about this combination is the toxicity profile. It is a very well-tolerated regimen as opposed to nivolumab plus ipilimumab, where the data suggest the combination is appropriate only for intermediate- and poor-risk patients.

Bradley McGregor, MD, physician, Genitourinary Oncology program, Dana-Farber Cancer Institute, instructor of medicine, Harvard Medical School, compares recent data with combination therapy in renal cell carcinoma.
 

Bradley McGregor, MD

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Dr. McGregor on Whether Patients Need Frontline Combinations in RCC

Dr. McGregor Compares Recent Data With Combinations in RCC