Dr. Somer on Optimal Combinations in mRCC

Bradley G. Somer, MD, an associate professor of hematology/oncology and head of strategic expansion/development at the University of Tennessee West Cancer Center, discusses optimal combinations for the treatment of patients with metastatic renal cell carcinoma (mRCC) in the frontline setting.

The combination of ipilimumab (Yervoy) and nivolumab (Opdivo) has shown promise in patients with intermediate- and poor-risk disease and has been approved by the FDA since April 2018. Data from the Impower150 trial with the combination of bevacizumab (Avastin) and the PD-L1 inhibitor atezolizumab (Tecentriq), in comparison with sunitinib (Sutent), have also been encouraging.

At the 2018 ESMO Congress, data were presented on the combination of avelumab (Bavencio) and axitinib (Inlyta), adds Somer. Moreover, the combination of pembrolizumab (Keytruda) and axitinib indicated a 47% reduction in the risk of death and a 31% reduction in the risk of disease progression or death over sunitinib monotherapy in the KEYNOTE-426 trial. In February 2019, the FDA granted a priority review designation to the combination of avelumab and axitinib in addition to pembrolizumab and axitinib as a frontline treatment for patients with advanced RCC. There are several positive combinations available, says Somer, but the question will be which ones will provide the most efficacy with the least adverse effects. In doing so, there will need to be a good biomarker predictive of response to these therapies, he adds.