Dr. Amin on Next Steps With Immunotherapy in Advanced RCC

Asim Amin, MD, PhD, director of immunotherapy, Levine Cancer Institute, discusses next steps with immunotherapy in the treatment of patients with advanced renal cell carcinoma (RCC).

In April 2018, the nivolumab (Opdivo) and ipilimumab (Yervoy) combination was FDA approved for the frontline treatment of patients with intermediate- or poor-risk advanced RCC. With the proof-of-concept for immunotherapy combinations in RCC, there has been significant interest in exploring other combinations, Amin says. In the CheckMate-214 study, response rates with combination immunotherapy were 40%, meaning that 60% of patients did not respond. This is still an area of unmet need, and Amin notes that work is ongoing to identify and overcome mechanisms of resistance to immunotherapy.

Understanding the tumor microenvironment is an important factor. Mechanistically, RCC is associated with increased VEGF, which is immunosuppressive. This can happen several different ways. Researchers know that VEGF can hinder dendritic cell function and increase regulatory T cells. Amin concludes that it may be logical to combine checkpoint inhibitors with VEGF tyrosine kinase inhibitors.