Dr Gopal on the Nuances of IO/TKI Selection in Advanced RCC

Nikhil A. Gopal, MD, assistant professor, urology, assistant professor, College of Medicine - Memphis, Department of Urology, The University of Tennessee Health Science Center, discusses the nuances of selecting between the currently available immuno-oncology (IO)/TKI approaches in advanced renal cell carcinoma.

When analyzing current data on ipilimumab (Yervoy) plus nivolumab (Opidvo), it's essential to consider the evolving landscape of treatment options for patients, Gopal begins. Unlike previous years when patients had fewer alternatives upon progression, the availability of various therapies now influences the interpretation of outcomes, he explains.

For example, the phase 3 CheckMate-214 trial (NCT02231749) demonstrated significantly higher overall survival (OS) and objective response rates (ORR) with nivolumab plus ipilimumab compared with sunitinib (Sutent) among intermediate– and poor-risk patients with previously untreated advanced RCC, Gopal expands.These results supported the FDA approval of nivolumab plus ipilimumab in this patient population on April 16, 2018. However, the trial was conducted at a time when immunotherapy was not as established, potentially impacting the observed reduction in OS benefits compared with more recent studies, Gopal states.

Overall, Gopal goes on to state that it is crucial to always rely on the available data. Ipilimumab with nivolumab demonstrates the longest OS benefit due to its extensive history in clinical use, he says. For patients who prioritize factors like quality of life and are capable of tolerating the increased adverse effects associated with dual immune checkpoint inhibitor therapy, this regimen may be favored over other agents, Gopal asserts. This decision-making process exemplifies the complexities faced by clinicians in selecting the most appropriate treatment strategy amidst a plethora of available options, he adds.

Ultimately, weighing the benefits and risks of each therapeutic approach in the context of individual patient characteristics and preferences is paramount, Gopal emphasizes. Despite the expanding treatment landscape, ensuring that patients receive personalized and optimized care remains a central tenet of oncology practice, he concludes.