Gurkamal Chatta, MD, professor of oncology and chief of genitourinary oncology at Roswell Park Cancer Institute in Buffalo, New York, said that improved understanding of kidney cancer is long overdue. Vascular endothelial growth factor (VEGF) inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and checkpoint inhibitors are helping significant numbers of patients. He noted, however, that there is still a long way to go: “they have a useful role, but we don’t know which patients respond best to them. Checkpoint inhibitors are showing great promise and have been a huge advance in treatment.
“Only about 30% to 35% of patients respond to these, however, and we don’t have biomarkers which predict responses. That is a big hurdle to overcome. These drugs are not cheap. We need to avoid side effects and financial toxicity.”
A recent study showed that overall survival (OS) was longer, and fewer grade 3 or 4 adverse events occurred, with the checkpoint inhibitor nivolumab, in contrast with everolimus for patients with advanced RCC.2 The randomized, open-label, phase 3 study included 821 patients, and it compared nivolumab to everolimus in patients with RCC who had received previous treatment. The researchers found that the median OS was 25.0 months with nivolumab, in contrast with 19.6 months with everolimus.
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“People have tried combinations of VEGF inhibitors and mTOR inhibitors, but the toxicity has been profound, and the responses not necessarily superior. That is 1 area where in the next year or 2 we are hopeful that combination therapy may be both better tolerated and more efficacious,” Dr Chatta said in an interview with Cancer Therapy Advisor. “Current treatments are targeted towards clear cell RCC, and in the majority of patients, the best response is either a partial response or stable disease. Patients often undergo continuous treatment. It would be nice to elicit complete responses and aim for curative therapy.”
- Ciccarese C, Brunelli M, Montironi, et al. The prospect of precision therapy for renal cell carcinoma Cancer Treat Rev. 11 Jul 2016. doi: 10.1016/j.ctrv.2016.07.003 [Epub ahead of print]
- Motzer RJ, Escudier B, McDermott DF, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015; 373(19):1803-13.