Dr Yentz on Treatment Decisions for Patients With Kidney Cancer

Sarah Elizabeth Yentz, MD, clinical assistant professor, Medical Oncology, Internal Medicine, the University of Michigan Rogel Cancer Center, discusses how she decides between an immunotherapy agent plus a TKI combination vs 2-agent immunotherapy for patients with renal cell carcinoma (RCC).

A patient with kidney cancer who's symptomatic and needs a quick response may benefit from an immunotherapy agent plus a TKI because the chance of response is generally higher with this combination, Yentz begins. Therefore, if a patient has intense symptoms, they should receive the treatment regimen that has the highest chance of working, she notes. Fortunately, many patients without intense symptoms have more time to think about treatment options. In those patients, treating oncologists consider immunotherapy monotherapy, Yentz explains.

Patients who receive immunotherapy/TKI regimens, generally receive the TKI for the rest of their lives, and continue the immunotherapy for at least 2 years, Yentz expands. However, some patients who receive 2-agent immunotherapy regimens, such as nivolumab (Opdivo) plus ipilimumab (Yervoy), respond well and can end their therapy earlier, she emphasizes.

As most immunotherapy and immunotherapy/TKI regimens are associated with similar overall survival (OS) outcomes, Yentz tends not to use OS as a measurement when deciding between the 2 approaches. The chance of having an immune-related adverse effect (AE) is higher with immunotherapy [than with TKIs], and these AEs tend to occur earlier, within the first 3 months of immunotherapy treatment, Yentz continues. However, the TKI-associated AEs are often more chronic and never go away, she notes. These AEs include hypertension and diarrhea, as well as rashes on hands and feet, she emphasizes. Dose modifications can increase the tolerability of TKIs, and patients can also take breaks from these treatments.

Overall, the efficacy and safety profiles of immunotherapy/TKI combinations and immunotherapy doublets should be considered when deciding between these 2 regimens, Yentz concludes.