Dr. Bakouny on the Utility of Checkpoint Inhibitors in Sarcomatoid RCC

Ziad Bakouny, MD, MSc, postdoctoral genitourinary oncology research fellow, Dana-Farber Cancer Institute, discusses the utility of checkpoint inhibitors in renal cell carcinoma (RCC) with sarcomatoid differentiation.

Sarcomatoid differentiation with or without rhabdoid differentiation is an aggressive subtype of RCC that accounts for 20% to 25% of all metastatic RCC, says Bakouny. This subtype is not common among patients with localized disease. However, patients with clear cell RCC or non-clear cell RCC who present with metastatic disease or who relapse may develop sarcomatoid differentiation, says Bakouny.

Therapies such as TKIs and rapalogs have expanded the armamentarium in RCC. However, patients with sarcomatoid differentiation have not historically derived significant benefit from these treatments, explains Bakouny.

However, novel combination regimens with immune checkpoint inhibitors such as nivolumab (Opdivo)/ipilimumab (Yervoy), avelumab (Bavencio)/axitinib (Inlyta), atezolizumab (Tecentriq)/bevacizumab (Avastin), and pembrolizumab (Keytruda)/axitinib appear to elicit significant activity and high complete response rates in this subgroup of RCC, concludes Bakouny.