Therapies used in the management renal cell carcinoma (RCC) include everolimus and tyrosine kinase inhibitors (TKIs). One of the most recent immunotherapy agents found to be effective in the treatment of RCC is the cancer checkpoint inhibitor, nivolumab, which targets programmed cell death protein 1 (PD-1). One of the challenges for oncologists is to determine at what point an individual may benefit from the use of a checkpoint inhibitor.

Brian Rini, MD, comments that researchers are currently developing biomarkers that may help determine whether a disease is susceptible to PD-1 inhibition, potentially aiding clinicians in deciding whether to initiate a checkpoint inhibitor and a TKI in sequence, or concurrently. Current data supports the use of a checkpoint inhibitor earlier in the disease course, an approach supported by Rini and his colleagues.

Janice Dutcher, MD, mentions that fewer individuals may respond to a checkpoint inhibitor than a TKI. Unlike with TKIs, those who respond to checkpoint inhibition may have a durable response even when they are off of therapy, an advantage that has also been observed with interleukin-2 (IL-2) therapy. Dutcher notes that 20 years passed before practitioners could better select appropriate IL-2 candidates, suggesting that time may also tell what population will benefit the most from checkpoint pathway inhibition.