Kidney Cancer Coverage from Every Angle

Choosing Among First-Line Treatments in Advanced Kidney Cancer

By: Celeste L. Dixon
Posted: Thursday, October 18, 2018

The Oncologist has provided a thorough review of current first-line treatments for advanced renal cell carcinoma as well as agents on the horizon likely to be used soon in this setting. Written by Emiliano Calvo, MD, of Centro Integral Oncológico Clara Campal and START Madrid, Madrid, Spain, and colleagues, the article highlights such agents as the VEGF-targeting tyrosine kinase inhibitors pazopanib and sunitinib as well as the recently approved (thanks to the CheckMate-214 trial) combination of the immune checkpoint inhibitors nivolumab and ipilimumab.

In the authors’ opinion, it is “unfortunate” that “treatment guideline recommendations provide little guidance to aid first‐line treatment choice.” So, their goal was to review “clinical trial and real‐world evidence for currently approved and investigational first‐line treatment regimens for advanced [renal cell carcinoma” to help oncologists make appropriate choices.

Among the currently available agents discussed are other tyrosine kinase inhibitors—bevacizumab, cabozantinib, tivozanib, axitinib, sorafenib—and mTOR inhibitors, especially temsirolimus, the only agent recommended in the first-line setting.

“Several ongoing randomized phase III trials of investigational first‐line regimens may complicate the renal cell carcinoma treatment paradigm if these agents gain approval,” the authors noted. They summarized the combinations being studied, including avelumab + axitinib, atezolizumab + bevacizumab, and nivolumab + cabozantinib.

In the coming years, Dr. Calvo and colleagues expect that innovations—especially in the first-line setting—will lead to even greater rates of long-term survival in advanced kidney cancer. “Treatment choice,” they added, “will be highly dependent on patients’ risk status per International Metastatic Renal Cell Carcinoma Database Consortium criteria.”

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