Dr. Sznol on Patient Selection for Combination Therapy in mRCC

Mario Sznol, MD, professor of medicine, co-director, Yale SPORE in Skin Cancer, Yale Cancer Center, discusses patient selection for combination therapy in metastatic renal cell carcinoma (mRCC).

The combination of ipilimumab (Yervoy) plus nivolumab (Opdivo) has not yet been compared head-to-head with anti—PD-1/VEGF TKI combinations, so it is not clear which approach is better, Sznol says. Moreover, the patient demographics were slightly different in the studies that pushed these regimens to the forefront. It is not sufficient to say that a particular regimen is better based solely on 1-year overall survival data, he adds.

Sznol says clinicians should look at individual subgroups of patients with mRCC stratified by risk, based on either the International Metastatic Renal Cell Carcinoma Database Consortium or Motzer criteria. It is probably best to look at PD-L1 expression, too. Sznol notes that he would give a PD-L1—negative patient with good-risk disease a PD-1 inhibitor plus a VEGF TKI, but would otherwise give ipilimumab plus nivolumab in the frontline setting.