Dr. McDermott on Single-Agent Pembrolizumab in Advanced RCC

David F. McDermott, MD, director of the Biologic Therapy Program at Beth Israel Deaconess Medical Center, discusses the use of single-agent pembrolizumab (Keytruda) in the treatment of patients with advanced non—clear cell renal cell carcinoma (RCC).

At the 2019 Genitourinary Cancers Symposium, there was a lot of excitement about data with combination immunotherapy and TKIs. However, little is known about single-agent PD-1 inhibitors in previously untreated patients, McDermott says, and so the KEYNOTE-427 trial was designed to address this unanswered question. At the 2018 ASCO Annual Meeting, investigators presented data with single-agent pembrolizumab in patients with clear cell RCC, which showed a 36% response rate and good tolerability.

This year, investigators presented data regarding the agent’s use in patients with non—clear cell renal cell carcinoma, said McDermott. Most of these patients had papillary disease, and there were some with chromophobe disease or unclassified histology. The response rate in the overall population was 25%, McDermott says, which was better than what the investigators had expected. Response rate was also 25% in the papillary group, 10% in the chromophobe group, and 34% in the unclassified group. Interestingly, for the patients who were PD-L1–high, the response rate was 30% compared with 10% in the PD-L1–low group, suggesting that PD-L1 status may be a way of enriching response to pembrolizumab.