Neeraj Agarwal, MD, discusses the efficacy of nivolumab and cabozantinib versus sunitinib in patients with previously untreated advanced or metastatic renal cell carcinoma in the phase 3 CheckMate-9ER trial.
Neeraj Agarwal, MD, director of the Genitourinary Oncology Program, Oncology Division, and professor of medicine at the Huntsman Cancer Institute, University of Utah, discusses the efficacy of nivolumab (Opdivo) and cabozantinib (Cabmetyx) versus sunitinib (Sutent) in patients with previously untreated advanced or metastatic renal cell carcinoma (RCC) in the phase 3 CheckMate-9ER trial (NCT03141177).
Agarwal thinks the amount of progression-free survival (PFS) benefit has not been observed before in this setting. The PFS for nivolumab and cabozantinib doubled compared with sunitinib, with a hazard ratio of 0.51. The median PFS was 16.6 months with the combination versus 8.3 months with monotherapy for these patients.
It’s important to note that this trial population was representative of what has been seen in the real world, according to Agarwal. There were 20% of patients in the favorable-risk category, and these patient’s usual tend to do better overall. Sixty percent of patients were in the intermediate-risk category, and 20% of patients were in the poor-risk category. This makes the group of patients on the study similar to the number of patients in each risk category off clinical trials.
The overall survival led to a 40% reduction in risk of death for those receiving the combination with a hazard ratio of 0.60. The median survival has not been reached in either arm, but the hazard ratio shows significant improvement, says Agarwal.