Dr. Ornstein on Challenges With Immunotherapy in RCC

Moshe Ornstein, MD, staff, Cleveland Clinic, discusses the challenges surrounding immunotherapy for patients with renal cell carcinoma.

Though checkpoint inhibitors have been impactful in this field, they do come with a handful of challenges, such as pseudoprogression, Ornstein explains. This leads to potentially having patients who seem to be progressing but are not, and are being taken off of treatment prior to them being able to have the optimal benefit.

Ornstein questions: how should physicians measure progressive disease in this setting? If a patient has progressive disease, can they be treated beyond their progression? Data from the CheckMate-025 trial showed that a handful of patients benefitted when they were treated beyond their disease progression.

Another challenge is the duration of therapy. Data suggest that there are a significant number of patients who will come off of therapy for nonprogressive disease reasons. Despite being off of therapy, they are able to sustain a long-term response without any subsequent treatment. This produces a dilemma to determine whether patients are being treated appropriately, in the sense that they are being treated continuously or indefinitely.