Nivolumab + Ipilimumab Therapy as Frontline Therapy for Advanced Renal Cell Carcinoma

Eric Jonasch, MD: Dr Bhatia, please describe your decision-making process in choosing ipilimumab-nivolumab for this patient. I know this was back when the other regimens weren’t approved, but if you could do it again, would you still see this patient as a very good candidate for ipilimumab-nivolumab? What would your differentiating factors be between I/O [immuno-oncology] and I/O–TKI [tyrosine kinase inhibitor]?

Sumeet Bhatia, MD: If this patient came in today, I probably wouldn’t have used nivolumab-ipilimumab. Most of these patients would have been treated with a TKI- and I/O–based regimen, so this has to do with the availability at that time, and nivolumab-ipilimumab does have far more toxicity compared with these other regimens. The factor that led me to never use nivolumab-ipilimumab up front is patients with hematuria. Though as you described in the previous case, you’ve done better with it. If somebody has brain metastases, that’s another reason why I will start with nivolumab-ipilimumab up front. But otherwise, in my practice, I’ve more or less moved to an I/O–TKI–based regimen. One thing that bothers me: what do we use after that when people relapse? Management of hypertension and the presence of comorbidities definitely guide our decision-making and how we choose what therapies for which patients.

Eric Jonasch, MD: Great. Thank you.

Transcript edited for clarity.