Dr. McGregor on Whether Patients Need Frontline Combinations in RCC

Bradley McGregor, MD, physician, Genitourinary Oncology program, Dana-Farber Cancer Institute, and instructor of medicine, Harvard Medical School, discusses whether patients with renal cell carcinoma (RCC) need frontline combination therapy.

Frontline combination therapies have taken hold of the RCC landscape, but physicians have yet to determine whether everyone should receive a frontline combination therapy, says McGregor. In the CheckMate-214 trial, the combination of ipilimumab (Yervoy) and nivolumab (Opdivo) was compared with sunitinib (Sutent) in the frontline setting and showed an improvement in overall survival. However, patients with good-risk disease demonstrated a higher rate of progression-free survival with sunitinib than with the combination.

Additionally, patients in the trial were accrued prior to the FDA’s approval of the combination in the United States. Less than 30% of patients who received sunitinib crossed over to receive immunotherapy in the trial. Researchers did not allow crossover until the data were reported, which was in 2016. Therefore, it is unknown if patients who receive frontline sunitinib and second-line immunotherapy experience the same magnitude of benefit, explains McGregor.