Dr. George on the Impact of Immunotherapy on TKIs in RCC

Daniel J. George, MD, professor of Medicine and Surgery, member, Duke Cancer Institute, discusses the impact of immunotherapy on TKIs in renal cell carcinoma (RCC).

Immunotherapies are a compliment to the field, says George. For patients with intermediate- and high-risk metastatic disease, combination immunotherapy with nivolumab (Opdivo) and ipilimumab (Yervoy) has been extremely valuable. Unfortunately, most patients who are treated with immunotherapy experience progression. The use of TKIs following immunotherapy has shown success in combating progression, adds George. Commonly used TKIs include pazopanib (Votrient), cabozantinib (Cabometyx), axitinib (Inlyta), lenvatinib (Lenvima), and everolimus (Afinitor).

For patients with good-risk disease, a single-agent, sequential approach is recommended, says George. In this space, immunotherapy has not been shown to be superior to sunitinib (Sutent) monotherapy. As such, VEGF TKIs are still the frontline treatment option in that setting. Though, providers are beginning to see more combinations of immunotherapy with VEGF TKIs emerge. To date, positive results from the JAVELIN Renal 101 study and the KEYNOTE-426 study suggest that there is a role for combining these agents in the frontline setting.