Kidney Cancer Journal 115
novel way of describing disease control and toxicity during
an off-treatment period, was longer in patients who
received nivolumab/ipilimumab in combination versus
those who received sunitinib, according to an innovative
analysis of the CheckMate 214 dataset. The study was
presented by Meredith M. Regan, MD of the Dana-Farber
Cancer Institute.
Dr Regan and colleagues previously defined TFS as the
interval between the time point of immune checkpoint
inhibitor (ICI) discontinuation and initiation of subsequent
systemic treatment (J Clin Oncol. 2019 Sep 9:JCO1900345.
doi:10.1200/JCO.19.00345). Development of this novel
outcome measure was based on the fact that ICI-treated
patients are observed to have continued benefit from
treatment or develop treatment-related adverse events
(TRAEs) after treatment discontinuation.
Incidence of Brain Metastases Is 4.5% in
Asymptomatic Metastatic RCC
MIAMI—Asymptomatic brain metastases are encountered
in 4.5% of asymptomatic metastatic renal cell carcinoma
(mRCC) patients according to a large multi-institutional
retrospective analysis of 1597 patients’ data. The study was
presented by Dr. Ritesh Kotecha of Memorial Sloan Kettering
Cancer Center.
Through a collaborative effort of scientists from the Institut
Gustav Roussy and Memorial Sloan Kettering Cancer
Center, investigators analyzed the data of 1597 asymptomatic
mRCC patients who were screened for brain metastases
for inclusion in 68 clinical trials. A total of 71 patients,
representing the 4.5% of the cohort, were found to have
brain metastases. Per IMDC criteria, 26%, 61%, and 13% of
the cohort were in favorable-, intermediate-, and poor-risk
groups, respectively. A majority of the patients were treatment
naïve (32%) or had received one prior line of treatment
(43%). A total of 86% of the patients had more than
one extracranial metastatic site, and the most common
accompanying extracranial metastatic site was lung (92%).
Patients with metastatic disease at initial presentation
comprised 60% of the patient population. The investigators
reported a median overall survival (OS) of 10.3 months
(95% CI, 7–17.9 months).
Living With Kidney Cancer, New Patient Magazine
The Kidney Cancer Association is launching a patient and
caretaker magazine called “Living with Kidney Cancer”. This
complimentary magazine is available for you to have in
your offices, waiting rooms, or to give specifically to patients.
Sign-up to receive your complimentary magazines
here: https://tinyurl.com/LivingWithKidneyCancer
William Kaelin’s 2019 Nobel Prize in Physiology
Linked to Kidney Cancer Molecular Mechanisms
William G. Kaelin Jr., MD, has won the 2019 Nobel Prize in
Physiology or Medicine with two other physician-scientists
for unraveling a molecular mechanism that not only is
crucial to survival, but is entwined with cancer and other
diseases, especially kidney cancer. Dr Kaelin is the Sidney
Farber Professor of Medicine at Harvard Medical School,
and an investigator at the Howard Hughes Medical
Institute.
Dr Kaelin and his collaborators deciphered the core
molecular events that explain how almost all multi-cellular
animals tune their physiology to cope with
varying quantities of life-sustaining oxygen
in a unique signaling scheme. Their findings
could lead to new therapeutics for a wide
range of disorders — including cancer,
cardiovascular disease, anemia, and macular
degeneration. This oxygen-sensing mechanism
involves the tumor-suppressor protein VHL, which is
mutated in many kidney cancers, and proteins known as
hypoxia inducible factors, HIF-1α and HIF-2α. Kaelin
showed that HIF-2α drives certain kidney cancers and recently
discovered how HIF-1α is hijacked by triple-negative
breast cancers. He is developing therapeutic strategies for
targeting these molecules and others implicated in cancer,
such as mutated enzymes IDH1 and IDH2, with designer
drugs.
2019 Top Stories in Oncology?
Pembrolizumab Plus Axitinib for RCC Heads the List
The pembrolizumab plus axitinib study is the renal cell
carcinoma top story for 2019, according to Eric Jonasch,
MD, a leading investigator on RCC trials and Professor,
Department of Genitourinary Medical Oncology,
Division of Cancer Medicine, The University
of Texas MD Anderson Cancer Center,
Houston.
Writing in the journal Oncology,
Dr Jonasch reported: KEYNOTE-426 was a
randomized phase III study designed to
compare the combination of axitinib and pembrolizumab
against sunitinib in patients with untreated clear cell renal
cell carcinoma.1 The study demonstrated superior overall
survival, response rate, and progression-free survival in
patients treated with the pembrolizumab plus axitinib
combination, while showing relatively low levels of toxicity.
This combination also appeared to show benefit across
all risk strata—good-, intermediate-, and poor-risk patients
all had superior outcomes in the combination arm.
Although the complete response rate of 6% was a bit lower
than the rate seen in the CheckMate 214 study published a
year earlier,2 the combination of efficacy, favorable toxicity,
and benefit across all risk groups makes the combination
of pembrolizumab plus axitinib a compelling choice for
patients with metastatic RCC choosing a front-line therapy.
1. Rini BI, Plimack ER, Stus V, et al. Pembrolizumab plus Axitinib versus
Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380(12):
1116-1127.
2. Motzer RJ, Tannir NM, McDermott DF, et al. Nivolumab plus Ipilimumab
versus Sunitinib in Advanced Renal-Cell Carcinoma. N Engl J Med. 2018;
378(14):1277-1290. KCJ
MEDICAL INTELLIGENCE
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