Dr Tykodi on Long-Term Outcomes for Nivolumab Plus Ipilimumab in Favorable-Risk Advanced RCC

One of the most provocative of pieces of data now is the long-term follow-up report [where we can] look at the duration of response of the responding patients and [at] how long responding patients maintained that response."

Scott Tykodi, MD, PhD, an associate professor in the Clinical Research Division and an affiliate investigator in the Translational Science and Therapeutics Division at Fred Hutchinson Cancer Center, as well as an associate professor in the Division of Hematology and Oncology at the University of Washington School of Medicine, discussed updated long-term findings from the phase 3 CheckMate 214 trial (NCT02231749) and their implications for the use of frontline nivolumab (Opdivo) plus ipilimumab (Yervoy) in patients with favorable-risk advanced renal cell carcinoma (RCC).

Although early data from CheckMate 214 initially suggested inferior outcomes for the dual immune checkpoint blockade compared with sunitinib (Sutent) in the subgroup of patients with favorable-risk disease, extended follow-up has demonstrated a more nuanced picture, Tykodi explained. Although objective response rates with the immune-onologoy (IO)–based combination remain lower compared with TKIs and IO/TKI combinations, the durability of response (DOR) with the IO/IO combination was vastly superior to sunitinib in CheckMate 214, he continued.

These findings are clinically meaningful, particularly when weighing initial tumor response against the potential for long-term disease control, Tykodi said. In favorable-risk patients—who often present with indolent, low-volume, and asymptomatic disease—nivolumab plus ipilimumab offers a compelling option for those seeking the possibility of prolonged remission with the potential for treatment-free intervals. Although complete radiographic responses are uncommon, many patients exhibit prolonged disease stability, suggesting an underlying state of immune-mediated tumor control or dormancy.

Despite these benefits, Tykodi acknowledged the limitations of imaging and the current challenges in predicting which patients will derive long-term benefit from an IO/IO combination. He emphasized the importance of close monitoring, as relapses can occur even after extended periods of apparent disease quiescence. Nevertheless, the prolonged durability of response observed with IO/IO comhination therapy underscores its potential value in select favorable-risk patients with advanced RCC, particularly those prioritizing long-term outcomes over rapid tumor shrinkage, Tykodi concluded.