Navigating an Optimal Treatment Course for Advanced Kidney Cancer.

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Date: June 2021
From: Oncology(Vol. 35, Issue 6)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 889 words
Lexile Measure: 1430L

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The authors of the accompanying article review the rapidly evolving treatment paradigms for renal cell carcinoma in both the first- and second-line settings. A remarkable sea change has occurred over the past 3-plus years, as the results of 5 separate positive phase 3 studies have demonstrated superiority of immunotherapy-containing regimens over monotherapy with the anti-VEGF tyrosine kinase inhibitor (TKI) sunitinib (Sutent) in the first-line setting. As a result, it is now the standard of care that most patients with advanced kidney cancer receive either combination immunotherapy or immunotherapy-TKI combinations. In fact, every eligible patient with advanced kidney cancer should receive immune checkpoint blockade during their treatment course, with the hope of deriving durable responses.

Nonetheless, the first question with regard to treatment sequencing is whether all patients with advanced/metastatic kidney cancer require up-front immuno-therapy, rather than second- or later-line immunotherapy. Let us first examine the data for International Metastatic RCC Database Consortium (IMDC) intermediate- and poor-risk disease. In this scenario, my answer is a resounding yes. Four FDA-approved options--axitinib (Inlyta) plus pembrolizumab (Keytruda), (1) lenvatinib (Lenvima) plus pembrolizumab, (2) cabozantinib (Cabometyx) plus nivolumab (Opdivo), (3) and ipilimumab (Yervoy) plus nivolumab (4)--demonstrated significantly improved overall survival (OS) in these cohorts. These regimens are all included as preferred options with category 1 evidence in the National Comprehensive Cancer Network guidelines. Axitinib plus avelumab (Bavencio)...

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Gale Document Number: GALE|A677572500