Which New Combination for Metastatic Renal Cell Cancer?

MUNICH—A leading European oncologist acknowledged the impressive life-extending potential of new drug combinations for metastatic renal cell carcinoma discussed at the 2018 annual congress of the European Society for Medical Oncology (ESMO). Progress was reported with purely immunological approaches—using two different programmed death ligand 1 (PD-L1) targeted immunotherapies together—and also with therapies combining immunotherapy with tyrosine kinase inhibitors (TKIs) of vascular endothelial growth factor (VEGF).

Although such combinations had improved progression free survival (PFS) and even promised prolongation of overall survival (OS) the lack of comparisons between them left clinicians with little guidance—other than toxicity profiles—upon which to individualize treatment for their patients.

No biomarkers

“Unfortunately we don’t have good biomarkers that would help us selecting patients who would benefit either from immunotherapy alone, VEGF targeting agents alone, or the combination. So we have to look at the safety profiles of the combinations that we have right now—either the combinations with immunotherapies (alone) or the combination of a VEGF targeting agent and an anti PD-L1 drug—and see what would be the best for the patient that you have in front of you,” the Audio Journal of Oncology heard from John B.A.G. Haanen MD PhD, Chief Scientific Officer Immunotherapy and Consultant Medical Oncologist in the Division of Medical Oncology and Immunotherapy at the Netherlands Cancer Institute in Amsterdam.