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, 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.