New Options for Renal Cell Carcinoma Could Offer Hope, But Sequencing and a Personalized Approach Are Critical

Clinical trials remain the gold standard when it comes to finding new treatment options for patients, particularly when it comes to renal cell carcinoma. But even if the results are positive and this combination proves to be beneficial, patients should still discuss all of their options with their oncologist to find the right sequence of treatment, says one expert.

Clinical trials remain the gold standard when it comes to finding new treatment options for patients, particularly when it comes to renal cell carcinoma (RCC). With the PDIGREE trial, which is currently enrolling patients in more than 700 locations across the country, researchers hope to investigate the addition of the VEGF tyrosine kinase inhibitor Cabometyx (cabozantinib) to the combination of Opdivo (nivolumab) and Yervoy (ipilimumab) in patients with metastatic untreated RCC.

But even if the results are positive and this combination proves to be beneficial, patients should still discuss all of their options with their oncologist to find the right sequence of treatment, says one expert.

In an interview with CURE®, researcher Dr. Tian Zhang of Duke Cancer Institute explained what positive results from the PDIGREE trial could mean for patients in a few years’ time and stressed the importance of “the art of practicing oncology.”

“If PDIGREE becomes positive, and I do hope it will, and I think it will, but we won't have that data for a couple of years at least, then it will really inform how patients and how practitioners will sequence these immunotherapy-based agents and hopefully optimize that sequencing,” Zhang said. “But a lot of questions are still unknown about the space, and I think it really depends on clinician judgment, which combination they pick up-front for their patients.”

Zhang is presenting on this in-progress trial at the virtual 2021 ASCO Genitourinary Cancers Symposium.

Transcription:

You know, there's so many options now for patients with kidney cancer and that's a great thing to have options. But these trials are really based on populations of patients who do better on the combination strategy versus sunitinib (Sutent). And we don't really have trials to compare against each other. So, we don't know, you know, for example, if the ipilimumab (Yervoy)/nivolumab (Opdivo) combination is better or not than axitinib (Inlyta)/pembrolizumab (Keytruda) or cabozantinib (Cabometyx)/nivolumab, or even lenvatinib (Lenvima)/pembrolizumab.

And so, it really is dependent on the clinician to kind of think about the patient in front of them and what characteristics they might have that might respond to a certain combination versus another. And I believe very strongly that that is the art of practicing oncology.

If PDIGREE becomes positive, and I do hope it will, and I think it will, but you know, we won't have that data for a couple of years at least, then it will really inform how patients and how practitioners will sequence these immunotherapy-based agents and hopefully optimize that sequencing. But a lot of questions are still unknown about the space, and I think it really depends on clinician judgment, which combination they pick up-front for their patients.