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We are reporting from the 2022 Genitourinary Cancers Symposium!

Get ready for highlights of some of the top news presented each day during the meeting—and soon Drs Toni Choueiri and Peter Van Veldhuizen will be with us to share some riveting results in renal cell carcinoma.

Welcome to OncLive News Network! I’m Gina Mauro.

Adjuvant pembrolizumab continued to demonstrate a consistent and clinically meaningful improvement in disease-free survival vs placebo in patients with renal cell carcinoma who were at high risk of recurrence, according to 30 months of follow-up of the phase 3 KEYNOTE-564 trial.

An East Asian subset of the phase 3 CLEAR trial showed that the combination of pembrolizumab and lenvatinib also showed consistent efficacy and safety data with this subgroup compared with the overall population of patients with advanced renal cell carcinoma.

Immune cell-related parameters, including higher percentages of blood-circulating 4-1BB+ CD4+ T cells and LAG3+ CD4+ T cells, were found to be associated with increased therapeutic efficacy with the combination of nivolumab and ipilimumab in clear cell RCC. These parameters, which were studied in the phase 2 TITAN-RCC trial, may represent novel predictive biomarkers for response.

In the single-arm, phase 2 NeoAvAx trial, neoadjuvant avelumab plus axitinib was found to lead to clinical responses in patients with non-metastatic high-risk renal cell carcinoma.

Long-term follow-up from the phase 3 TIVO-3 trial showed that patients with relapsed/refractory renal cell carcinoma were 5 times more likely to experience long-term PFS compared with sorafenib. Investigators noted that a clinically relevant minority of patients are alive and progression-free on tivozanib at 3- and 4-years.

Please be sure to check out more of our coverage from the 2022 ASCO GU meeting at OncLive.com.

That’s all for today. Thank you for watching OncLive News Network: On Location. Signing off from the 2022 Genitourinary Cancers Symposium, I’m Gina Mauro.

Videos

OncLive® speaks with Drs. Toni Choueiri and Peter Van Veldhuizen on the latest studies in renal cell carcinoma that were presented during the 2022 Genitourinary Cancers Symposium. 

ASCO GU 2022: Reflecting on RCC Data With Drs. Toni Choueiri and Peter Van Veldhuizen

Peter J. Van Veldhuizen, MD, hematologist/oncologist, Sarah Cannon Research Institute, discusses combination therapy for the treatment of patients with renal cell carcinoma (RCC).

As there are not many active chemotherapeutic drugs in the RCC landscape, Van Veldhuizen says that combinations lie with targeted agents. Older studies with immunotherapy and the VEGF inhibitor pazopanib (Votrient) caused concern over toxicity and has consequently not moved forward.

Another potential combination may be with axitinib (Inlyta) and pembrolizumab (Keytruda), suggests Van Veldhuizen. Findings from a phase Ib study have shown antitumor activity with the combination, activity which is superior to that expected from axitinib or PD-L1 pathway inhibitor monotherapy in treatment-naïve patients. Additionally, fewer liver function test abnormalities and less fatigue were reported compared with other combinations of VEGF inhibitors and PD-1 checkpoint inhibitors. Axitinib is currently used as a second-line treatment for RCC.

Peter J. Van Veldhuizen, MD, hematologist/oncologist, Sarah Cannon Research Institute, discusses combination therapy for the treatment of patients with renal cell carcinoma. 

Dr. Van Veldhuizen Discusses Combination Therapy in RCC

Peter J. Van Veldhuizen, MD, hematologist/oncologist, Sarah Cannon Research Institute, discusses frontline immunotherapy for the treatment of patients with kidney cancer.

The nivolumab (Opdivo) and ipilimumab (Yervoy) combination has been exciting, Van Veldhuizen says, because it resulted in some complete responses in clinical trials. The tolerability in some patients remains an unanswered question, so performance status and age should play a role in deciding if this regimen is the right treatment. An exploratory analysis has also suggested that PD—L1-positive patients with intermediate- or high-risk disease will benefit the most from immunotherapy. Therefore, Van Veldhuizen says, PD–L1 status could be a good biomarker in deciding if immunotherapy or a tyrosine kinase inhibitor (TKI) is better for a patient.

Cabozantinib (Cabometyx) and pazopanib (Votrient) have emerged as effective TKIs for patients who are ineligible for immunotherapy.

Dr. Van Veldhuizen on Frontline Immunotherapy for Kidney Cancer

Peter J. Van Veldhuizen, MD, hematologist/oncologist, Sarah Cannon Research Institute, discusses the impact of the CARMENA trial results in renal cell carcinoma (RCC).

Findings from the phase III CARMENA trial showed that sunitinib (Sutent) alone was noninferior for median overall survival compared with sunitinib plus cytoreductive nephrectomy in patients with synchronous metastatic RCC. Smart patient selection is of the utmost importance, Van Veldhuizen says. CARMENA showed that patients who have more extensive metastatic disease or a smaller primary lesion are less likely to benefit from cytoreductive nephrectomy.

Van Veldhuizen says that he hopes these results do not shift the standard of care too far away from debulking nephrectomy. There is still a clear benefit in utilizing surgery in select patients, such as those with a primary lesion or small-volume systemic disease, as well as patients with a better performance status.

In addition, there is also question of the role of cytoreductive nephrectomy in the age of immunotherapy, Van Veldhuizen adds.

Peter J. Van Veldhuizen, MD, hematologist/oncologist, Sarah Cannon Research Institute, discusses the impact of the CARMENA trial results in renal cell carcinoma. 
 

Dr. Van Veldhuizen Reflects on the CARMENA Trial in RCC

Peter J. Van Veldhuizen, MD, hematologist/oncologist, Sarah Cannon Research Institute, discusses the frontline combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) in the treatment of patients with kidney cancer.

The rationale behind the combination of bevacizumab and atezolizumab is bevacizumab’s potential synergistic effects with immunotherapy. Even though these agents are administered intravenously, they are fairly well tolerated, says Van Veldhuizen. There is good rationale and science to support the combination in the hope of enhancing the immune response.

Data from the phase III IMmotion151 study revealed that the combination reduced the risk of progression or death by 26% compared with sunitinib (Sutent) for patients with untreated PD-L1—positive metastatic renal cell carcincoma.

Physicians are seeing more of these combinations improve overall responses (OS), states Van Veldhuizen. It is difficult to predict where the combination will fall in the treatment paradigm, says Van Veldhuizen, but its FDA approval may provide physicians an alternative to the combination of nivolumab (Opdivo) and ipilimumab (Yervoy). Atezolizumab and bevacizumab would offer patients a frontline immunotherapy that may have some better tolerability, states Van Veldhuizen.

Peter J. Van Veldhuizen, MD

Articles

ASCO GU 2022: Reflecting on RCC Data With Drs. Toni Choueiri and Peter Van Veldhuizen

Dr. Van Veldhuizen Discusses Combination Therapy in RCC

Dr. Van Veldhuizen on Frontline Immunotherapy for Kidney Cancer

Dr. Van Veldhuizen Reflects on the CARMENA Trial in RCC

Dr. Van Veldhuizen on the Combination of Atezolizumab and Bevacizumab in Kidney Cancer