Dr Grivas on Frontline Treatment Options in Metastatic RCC

Petros Grivas, MD, PhD, professor, Clinical Research Division, Fred Hutchinson Cancer Center; professor, Division of Hematology and Oncology, University of Washington (UW) School of Medicine; clinical director, Genitourinary Cancers Program, UW Medicine, discusses frontline treatment options for patients with metastatic renal cell carcinoma (RCC).

In the frontline setting of metastatic RCC, several doublet therapies have redefined the standard of care, Grivas says. For example, ipilimumab (Yervoy) plus nivolumab (Opdivo) was approved by the FDA in 2018 for patients with previously untreated intermediate– and poor-risk, advanced RCC based on findings from the phase 3 CheckMate 214 trial (NCT02231749). Furthermore, pembrolizumab (Keytruda) in combination with axitinib (Inlyta) received FDA approval in 2019 for patients with treatment-naive advanced RCC based on findings from the phase 3 KEYNOTE-426 trial (NCT02853331).

Additionally, frontline cabozantinib (Cabometyx) plus nivolumab was approved by the FDA in 2021 for patients with advanced RCC. This regulatory decision was supported by findings from the phase 3 CheckMate-9ER trial (NCT03141177). Moreover, pembrolizumab plus lenvatinib (Lenvima) was FDA approved in 2021 for patients with previously untreated advanced RCC. This regulatory decision was backed by findings from the phase 3 CLEAR/KEYNOTE-581 trial (NCT02811861).

In an OncLive® State of the Science Summit™ on genitourinary cancer, which Grivas co-chaired, Scott Tykodi, MD, PhD, of Fred Hutchinson Cancer Center, gave a presentation on the frontline management of metastatic RCC, in which he discussed clinical research that has contributed to the expansion of frontline treatment in RCC.

Tykodi also discussed the phase 3 COSMIC-313 trial (NCT03937219) of ipilimumab plus nivolumab and cabozantinib vs placebo in patients with treatment-naive, advanced clear cell RCC. Findings from this study had previously been presented during medical meetings, Grivas explains, saying that COSMIC-313 met its coprimary end point of PFS. However, the triplet is not used in clinical practice because COSMIC-313 did not demonstrate an OS benefit with the regimen, which was also associated with significant toxicity, Grivas notes. Ongoing research in the frontline metastatic setting of RCC is necessary for further treatment advances in this field, Grivas concludes.