Elizabeth Wulff-Burchfield, MD

Elizabeth Wulff-Burchfield, MD, assistant professor, Divisions of Medical Oncology and Palliative Medicine and medical director of Palliative and Geriatric Oncology Services, The University of Kansas Health System, discusses the role of immune checkpoint inhibitor combination therapy in metastatic renal cell carcinoma (RCC).

The most common frontline treatments for patients with metastatic RCC include a number of checkpoint inhibitor combinations, either with other checkpoint inhibitors or tyrosine kinase inhibitors. Wulff-Burchfield says these regimens currently include axitinib (Inlyta) plus avelumab (Bavencio), axitinib plus pembrolizumab (Keytruda), and nivolumab (Opdivo) plus ipilimumab (Yervoy). Findings from the phase 3 CheckMate-9ER clinical trial demonstrated promise for the combination of nivolumab plus cabozantinib (Cabometyx) in this space as well.

There is worry in the community that preoperative checkpoint inhibition could increase risk of some dismal reactions, Wulff-Burchfield says, and this could make operation difficult. Given that this is not the same as neoadjuvant therapy and these patients need a response for quality of life, the ethical framework and data support use of these combination regimens with checkpoint inhibitors, but if operation is a secondary goal for the patient, she says she would consider this within the first 3 to 6 months.

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Elizabeth Wulff-Burchfield, MD, discusses the role of immune checkpoint inhibitor combination therapy in metastatic renal cell carcinoma.

Immune Checkpoint Inhibitor Combinations Play Important Role in Metastatic RCC

Elizabeth Wulff-Burchfield, MD, assistant professor, Divisions of Medical Oncology and Palliative Medicine and medical director of Palliative and Geriatric Oncology Services, The University of Kansas Health System, advises physicians on how to make appropriate treatment decisions for patients with unresectable kidney cancer.

Treatment decisions should primarily depend on several patient characteristics, such as their functional status, goals for treatment, and tolerance for medical burden, Wulff-Burchfield says. Should the patient’s goal be to pursue more aggressive care and systemic therapy in order to both achieve good responses and improve symptom burden, she says she would prioritize treatment based on overall responses rates.

For patients who are more medically frail, or have comorbidities putting them at a higher risk for a rapid decline in function status or overall well-being, it is reasonable to consider a single-agent tyrosine inhibitor, according to Wulff-Burchfield. If a patient can tolerate more aggressive care, it would be appropriate to use a tyrosine kinase inhibitor in combination with an immune checkpoint inhibitor.

Elizabeth Wulff-Burchfield, MD, advises physicians on how to make appropriate treatment decisions for patients with unresectable kidney cancer.

Elizabeth Wulff-Burchfield, MD | Authors

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Immune Checkpoint Inhibitor Combinations Play Important Role in Metastatic RCC

Selecting Appropriate Treatments for Patients With Unresectable Kidney Cancer