Dr. Pal on the Clinical Utility of PD-L1 in mRCC

Sumanta Kumar Pal, MD, a medical oncologist at City of Hope, discusses the clinical utility of PD-L1 in metastatic renal cell carcinoma (mRCC).

PD-L1 is not an integral piece of information that physicians need to know to select therapy for patients with RCC right now, explains Pal. However, many of Pal’s patients come to the clinic with genomic profiling and PD-L1 status, he says. In that case, it may be appropriate to use a patient’s PD-L1 status to decide between a VEGF TKI or the combination of ipilimumab (Yervoy) and nivolumab (Opdivo) if they are suited to receive both.

Several immunotherapy and VEGF TKI combinations are under investigation, including axitinib (Inlyta) and avelumab (Bavencio)—which has been shown to improve progression-free survival (PFS) in both PD-L1—positive and –negative patients—and axitinib and pembrolizumab (Keytruda). Data from those trials will further inform the potential application of PD-L1 in this disease, adds Pal.

Of the immunotherapy/VEGF TKI combinations under investigation, the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) is the most mature. At a median follow-up of 15 months, the median PFS was 11.2 months with the combination and 7.7 months with sunitinib (Sutent) monotherapy. In terms of axitinib and pembrolizumab, physicians are anticipating the results of the phase III KEYNOTE-426 trial, after a press release suggested that the combination resulted in a significant improvement in PFS in patients with advanced or metastatic RCC.