The Exciting Present and Future of Kidney Cancer Care

The treatment paradigm in renal cell carcinoma (RCC) has expanded over recent months to include three practice-changing agents in the second-line setting. 
BY GINA COLUMBUS @ginacolumbusonc
PUBLISHED: JUNE 24, 2016
Patients with renal cell carcinoma (RCC) have more treatment options than ever, as the three practice-changing agents were recently approved in the second-line setting: Opdivo (nivolumab), Cabometyx (cabozantinib) and the combination of Lenvima (lenvatinib) and Afinitor (everolimus).
 
Most recently, the FDA approved the two-drug regimen of Lenvima and Afinitor in May 2016 for patients with advanced RCC who previously received antiangiogenic therapy. Cabometyx, a multikinase inhibitor, was approved by the FDA in April 2016 for the same indication.

Additionally, the FDA approved the PD-1 inhibitor Opdivo in November 2015 as a treatment for patients with metastatic disease following prior antiangiogenic therapy.

“We now have three therapies that have raised the bar and therapies that have shown, for the first time ever, that we could impact survival in patients with kidney cancer,” says Thomas E. Hutson.

Researchers are still investigating the full potential of each of these agents and exploring them in combination with other immune-based and targeted therapies in other settings, he adds.

For example, frontline treatment with Cabometyx has been shown to significantly improve progression-free survival (PFS) in patients with advanced disease in the phase 2 CABOSUN trial; full results of the study will be presented at an upcoming medical meeting.

In an interview with CURE, Hutson, director of the Genitourinary Oncology Program, Charles A. Sammons Cancer Center at Baylor University Medical Center, discusses how these three agents have significantly impacted the management of patients with RCC and promising combination regimens on the horizon to propel the field forward.
 

There have been some exciting advancements in this field recently. Can you speak to how far we have come and where we are going?


Certainly, in the past five years, we have come a long way. In the last 10 years, we went from having no proven therapy that would work in the majority of folks, to now having eight therapies in the past five years. The biggest issue is that, in the past six months, we have approved three new therapies. That has been the change.

For the most part, we did not have therapies that could prolong survival that we could show in a clinical trial. All of the therapies we had approved were based on a PFS endpoint. With Opdivo, Cabometyx and Lenvima, we have now three data sets that show that patients who get those therapies have PFS advantages in regards to Cabometyx and Lenvima, have objective tumor response benefits with all three, and have an overall survival benefit with all three. That has been a major advance.

Since this just happened in the last six months, it is going to take time for us to sort through that data and try to figure out how we are going to best utilize these agents in our patients. However, I can rest assured that all three of these agents have a role to play in our patient management.



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