Dr. Hammers on the Safety Profile of Lenvatinib/Pembrolizumab in RCC

Hans Hammers, MD, PhD, associate professor of internal medicine, Eugene P. Frenkel, MD Scholar in Clinical Medicine, Division of Hematology-Oncology, The University of Texas Southwestern Medical Center, discusses the safety profile of lenvatinib (Lenvima) in combination with pembrolizumab (Keytruda) in renal cell carcinoma (RCC).

Most of the toxicities observed with lenvatinib plus pembrolizumab were anticipated and associated with TKIs, Hammers says. However, the combination did not induce a high rate of liver toxicities, which is unique among the available TKI/immunotherapy combinations in RCC. Moreover, this could be a reason that patients were able to tolerate lenvatinib at a higher dose compared with other TKIs, Hammers adds.

Ultimately, utilizing lenvatinib plus pembrolizumab may require more monitoring for dose adjustments and reductions, Hammers says. However, all the TKI/immunotherapy combinations are reasonable options for patients with RCC. It is generally recommended to move forward with a TKI/immunotherapy combination rather than single-agent treatment, Hammer says. Additionally, the rates of progressive disease as best response were similar between nivolumab plus cabozantinib (Cabometyx) and lenvatinib plus pembrolizumab, so both options are active for patients, Hammers concludes.