Kidney Cancer Journal 29
of the CheckMate-214 trial and take into account
guidelines from the International mRCC Database
Consortium (IMDC). Yes, the combination was superior
to sunitinib in patients with intermediate- and poor-risk
disease. Notably, however, the schedule modifications
of sunitinib, routinely adapted in the general practice
and shown to be associated with greater clinical benefit
in some patients as compared to the standard 4 weeks
ON 2 weeks OFF schedule, were not contemplated in
the study. Furthermore, those with favorable risk disease
had better results with sunitinib in terms of overall
response rate and progression-free survival.
The excitement surrounding immunotherapy may
obscure the compelling need to choose the most effective
therapy based on evidence for a particular patient
at a given time point. For example, how should
clinicians consider PD-L1 expression as they contemplate
the use of a checkpoint inhibitor? How many of
us are mindful of data showing that improvement is
likely to be more pronounced in those with tumor
PD-L1 expression of 1% or more? What’s needed in the
calculus is to determine how such markers not only
could have an impact on therapeutic choices but on
expected outcomes.
These are nuances that are all part of the exciting
narrative on treatment selection as we continue to see
inflection points in therapy emerge from new data. And
they will remain so as the search for predictive biomarkers
goes on. Until those biomarkers are revealed, an attempt
to administer as many efficacious and reasonably
tolerated agents will often be the “default” setting
of most clinicians, based on NCCN guidelines, other
widely accepted protocols and patient preference. At
the same time, the need to drill down and discover the
“devil in the details” will help provide an important
dimension to clinical decision making and appropriate
choices.
Roberto Pili, MD
Guest Editor
Robert Wallace Miller Professor of Oncology
Co-Leader, Experimental and Developmental
Therapeutics Program
Director, Genitourinary Oncology
Professor of Medicine, Urology, Pharmacology
and Toxicology
Indiana University School of Medicine –
Simon Cancer Center
Indianapolis, Indiana
GUEST EDITOR’S MEMO
(continued from page 6)
Kidney Cancer Journal,
Now in Its 16th Year
• Highlights from the 2018 Scientific Sessions of the
American Society of Clinical Oncology (ASCO)
• Analysis of Trends in Treatment
• Emerging Data on Key Issues Affecting Clinical
Decision Making
• A Round Table Discussion With Thought Leaders on
Newly Recognized Shifts in the Treatment Paradigm