Dr. Choueiri on Biomarkers in RCC

Toni Choueiri, MD, director of the Lank Center for Genitourinary Oncology, director of the Kidney Cancer Center, and Jerome and Nancy Kohlberg Associate Professor of Medicine at Harvard Medical School, Dana-Farber Cancer Institute, discusses biomarkers in renal cell carcinoma (RCC).

Treatment with checkpoint inhibitors and VEGF tyrosine kinase inhibitors (TKIs) have become the standard of care for patients with advanced RCC, but right now, there is not an effective biomarker predictive of response to these therapies, Choueiri says. PD-L1 expression, which has had success as a biomarker particularly in lung cancer, has had mixed results in RCC. However, available evidence suggests that PD-L1—positive patients do worse with systemic therapy, Choueiri notes.

In the phase III CheckMate-025 trial—which showed clear survival benefit and response rates in patients treated with nivolumab (Opdivo) compared with VEGF TKI therapy—patients derived benefit irrespective of PD-L1 expression, according to Choueiri. However, PD-L1 positivity was associated with worse outcomes. Conversely, data from the CheckMate-214 trial suggested that patients who were PD-L1—positive seemed to do better with immunotherapy than with sunitinib (Sutent).