Roundtable Roundup: Polling Physicians on Use of Frontline Therapies in RCC

Case-Based Roundtable Meetings Spotlight, Case-Based Roundtable Meetings Spotlight: July 2, 2022,
Pages: 41

During separate virtual live events, Sandy T. Liu, MD, and Moshe Ornstein, MD, MA, discussed what treatment they would choose for a patient with clear cell renal cell carcinoma and the trial data available in this setting.

CASE SUMMARY

A 59-year-old Black woman received a diagnosis of clear cell RCC. She underwent left total nephrectomy in December 2019. Nine months later, she developed metastatic disease to bilateral lungs, mediastinum (35 × 38 mm), and retroperitoneal lymph nodes. She was diagnosed with stage IV RCC, clear-cell histology, with metastases to lung and retroperitoneum. Her Karnofsky performance status score was 90%. Her hemoglobin was 11.1 g/dL, and her corrected calcium, neutrophils, and platelet levels were within normal limits.

“A decision was made to initiate systemic therapy. What frontline therapy are you most likely to choose for this patient?”

“All these combinations were compared against the same historical standard of sunitinib [Sutent]. The makeup of the trials was fairly similar; they had the same control arm. I think there’s at least enough of a rationale to compare them in some capacity.”

—MOSHE ORNSTEIN, MD, MA

REFERENCES

1. Motzer RJ, Tannir NM, McDermott DF, et al. 661P Conditional survival and 5-year follow-up in CheckMate 214: First-line nivolumab + ipilimumab (N+I) versus sunitinib (S) in advanced renal cell carcinoma (aRCC). Ann Oncol. 2021;32(suppl 5):S685-S687. doi:10.1016/j.annonc.2021.08.057

2. Albiges L, Tannir NM, Burotto M, et al. Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended 4-year follow-up of the phase III CheckMate 214 trial. ESMO Open. 2020;5(6):e001079. doi:10.1136/esmoopen-2020-001079

3. Rini BI, Plimack ER, Stus V, et al. Pembrolizumab (pembro) plus axitinib (axi) versus sunitinib as first-line therapy for advanced clear cell renal cell carcinoma (ccRCC): Results from 42-month follow-up of KEYNOTE-426. J Clin Oncol. 2021;39(suppl 15):4500. doi:10.1200/JCO.2021.39.15_suppl.4500

4. Powles T, Plimack ER, Soulières D, et al. Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): extended follow-up from a randomised, open-label, phase 3 trial [published correction appears in Lancet Oncol. 2020 Dec;21(12):e553]. Lancet Oncol. 2020;21(12):1563-1573. doi:10.1016/S1470-2045(20)30436-8

5. Choueiri TK, Powles T, Burotto M, et al. Nivolumab plus Cabozantinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2021;384(9):829-841. doi:10.1056/NEJMoa2026982

6. Apolo AB, Powles T, Burotto M, et al. Nivolumab plus cabozantinib (N+C) versus sunitinib (S) for advanced renal cell carcinoma (aRCC): Outcomes by baseline disease characteristics in the phase 3 CheckMate 9ER trial. J Clin Oncol. 2021;39(suppl 15):4553. doi:10.1200/JCO.2021.39.15_suppl.4553

7. Powles T, Choueiri TK, Burotto M, et al. Final overall survival analysis and organ-specific target lesion assessments with two-year follow-up in CheckMate 9ER: Nivolumab plus cabozantinib versus sunitinib for patients with advanced renal cell carcinoma. J Clin Oncol. 2022;40(suppl 6):350. doi:10.1200/JCO.2022.40.6_suppl.350

8. Motzer R, Alekseev B, Rha SY, et al. Lenvatinib plus Pembrolizumab or Everolimus for Advanced Renal Cell Carcinoma. N Engl J Med. 2021;384(14):1289-1300. doi:10.1056/NEJMoa2035716

9. Grunwald V, Powles T, Kopyltsov E, et al. Analysis of the CLEAR study in patients (pts) with advanced renal cell carcinoma (RCC): Depth of response and efficacy for selected subgroups in the lenvatinib (LEN) + pembrolizumab (PEMBRO) and sunitinib (SUN) treatment arms. J Clin Oncol. 2021;39(suppl 15):4560. doi:10.1200/JCO.2021.39.15_suppl.4560

10. Choueiri TK, Powles T, Porta C, et al. A phase 3 trial of lenvatinib plus pembrolizumab versus sunitinib as a first-line treatment for patients with advanced renal cell carcinoma: overall survival follow-up analysis (the CLEAR study). Presented at: Kidney Cancer Research Summit; October 7-8, 2021; Philadelphia, PA. Accessed June 29, 2022. https://bit.ly/3OUldIK