Dr Qin on Emerging Treatment Options in ccRCC

Qian (Janie) Qin, MD, assistant professor, Division of Hematology and Oncology, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, discusses emerging treatment regimens for patients with advanced clear cell renal cell carcinoma (ccRCC).

In the field of advanced ccRCC, emerging treatment approaches have shifted toward combination therapies, Qin begins. These combinations encompass either dual immunotherapy regimens, such as the notable ipilimumab (Yervoy) and nivolumab (Opdivo) doublet pairing, or an immunotherapy agent combined with a VEGF TKI, Qin explains.

When considering treatment with immunotherapy combined with a VEGF TKI, there are 4 prominent choices within the current treatment landscape, Qin expands. Three of these regimens, pembrolizumab (Keytruda) combined with axitinib (Inlyta), nivolumab combined with cabozantinib (Cabometyx), and pembrolizumab combined with lenvatinib (Lenvima), are all approaches that are typically preferred by oncologists, given that the survival data with the fourth combination, avelumab (Bavencio) combined with axitinib, are not yet sufficiently mature, Qin emphasizes. Despite the considerable improvement in response rates achieved with these therapies, further progress is needed to induce more complete responses and improve response rates for patients, Qin notes.

Promising treatment alternatives have emerged for patients with advanced or metastatic RCC, Qin continues, citing that triplet therapy approaches targeting the HIF pathway have been introduced. In addition, novel immunotherapies and VEGF TKIs are in the developmental pipeline, she adds. Within the realm of kidney cancer treatment are innovative therapies featuring unique mechanisms of action, such as the phase 3 COSMIC-313 trial (NCT03937219) regimen. Other ongoing trials are exploring various triplet therapy combinations alongside the investigation of the HIF2α inhibitor belzutifan (Welireg) and potential treatments related to the HIF2 pathway, such as ARO-HIF2, that target resistance to HIF2-directed drugs, Qin notes. Furthermore, ongoing evaluations of emerging single-agent, double-agent, and triplet therapies are incorporating belzutifan, she says. Novel mechanisms are also being explored, encompassing CAR T-cell therapy and radioligand therapy, Qin concludes.