Bradley McGregor, MD, clinical director, Lank Center for Genitourinary Oncology, senior physician, Dana-Farber Cancer Institute, and instructor of medicine, Harvard Medical School, discusses how to choose between combination treatments in advanced renal cell carcinoma (RCC).
Three combinations, nivolumab (Opdivo) and ipilimumab (Yervoy), pembrolizumab (Keytruda) and axitinib (Inlyta), and axitinib and avelumab (Bavencio), were shown to be superior to sunitinib (Sutent) in clinical trials. However, these combinations have not been compared to one another, which poses a potential challenge in choosing between them in practice, says McGregor.
Although well tolerated, the combination of axitinib and avelumab has not yet shown an overall survival (OS) benefit in the frontline setting, explains McGregor. He adds that nivolumab and ipilimumab has mainly shown benefit in patients with intermediate- and poor-risk disease while pembrolizumab and axitinib was effective in all risk groups.
Ultimately, it comes down to patient preference, says McGregor. Avelumab and axitinib has reported an almost 10% complete response rate but with significant adverse events, which can be deterring for patients. Some patients may decide against a particular combination due to the potential immune-related adverse events or because an oral medication is preferred, he adds.