ASCO 2018: Measurable Immunologic Changes and Improved Clinical Activity in mRCC with Nivolumab + Bevacizumab or Nivolumab + Ipilimumab
Chicago, IL (UroToday.com) Frontline therapy for metastatic renal cell carcinoma has changed dramatically over the past 25 years. The therapies exploit different biologic pathways which are dysregulated in RCC, including targeting vascular endothelial growth factor, fibroblast growth factor, stem-cell factor, and platelet-derived growth factor via tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin (mTOR) inhibitors1. Immunotherapy was there at the very beginning with IL-2 – however, only a small portion of patients had a durable benefit2.
ASCO 2018: CABOPRE: Phase II Study of Cabozantinib Prior to Cytoreductive Nephrectomy in Locally Advanced and/or Metastatic Renal Cell Carcinoma
Chicago, IL (UroToday.com) The current standard of care for patients with metastatic RCC is cytoreductive nephrectomy, followed by vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI) therapy. With this type of therapy, patients need to recover from their surgery before starting TKI therapy. Up to 50% of patients do not receive TKI therapy in a timely manner.
ASCO 2018: KEYNOTE-564: A Phase 3, Randomized, Double Blind, Trial of Pembrolizumab in the Adjuvant Treatment of Renal Cell Carcinoma
Chicago, IL (UroToday.com) There are plenty of effective adjuvant therapies for patients with renal cell carcinoma (RCC), who are at risk for recurrence after nephrectomy [1,2]. Treatment with inhibitors of the vascular endothelial growth factor receptor (VEGFR) have been extensively studied in the setting of adjuvant treatment. However, they are currently not recommended as treatment.
The expression of programmed death 1 (PD-1) ligands 1 (PD-L1) and 2 (PD-L2) could potentially predict poor prognosis in clear cell RCC disease. Furthermore, PD1 inhibitors were shown to have activity in metastatic RCC patients, and PD-1 may represent a new therapeutic target in the adjuvant setting. Pembrolizumab, a PD-1 inhibitor, has been shown to have antitumor activity with a relatively good safety profile in several tumors.
ASCO 2018: Nivolumab for Patients with Metastatic Non-Clear Cell Renal Cell Carcinoma: A Single-Institution Experience
Chicago, IL (UroToday.com) Nivolumab alone and in combination with ipilimumab are currently FDA approved for patients with metastatic clear cell RCC (MRCC) as 2nd line therapy, and those who are treatment naïve, respectively. Variant histology RCC (VHRCC) to date have very limited therapeutic options and poor outcomes, when compared to clear cell RCC. The role nivolumab in VHRCC is unknown.
ASCO 2018: Effectiveness and Safety of Pazopanib and Everolimus in a Changing Treatment Landscape: Interim Results of the Non-Interventional Study PAZOREAL
Chicago, IL (UroToday.com) Pazopanib, a vascular endothelial growth factor receptor (VEGFR) inhibitor is one of the standard approved treatment options for patients with metastatic renal cell carcinoma (mRCC). One of the potential 2nd line treatment is everolimus, a mammalian target of rapamycin (mTOR) inhibitor. However, in recent years, several additional drugs have been approved for 2nd line treatment. These include the immune checkpoint inhibitors nivolumab (an immune checkpoint [PD-1] inhibitor), and the multikinase inhibitors: cabozantinib and lenvatinib (in combination with everolimus). Because of these newly approved treatments, the therapeutic algorithms for patients with mRCC have considerably changed.
ASCO 2018: Prospective, Multinational, Observational Study of Real-World Treatment Outcomes with Pazopanib in Patients with Advanced or Metastatic Renal Cell Carcinoma (Principal Study)
Chicago, IL (UroToday.com) Pazopanib and Sunitinib are vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs), which are established as first-line treatment options for patients with advanced or metastatic renal cell carcinoma (RCC). Pazopanib has been approved for the treatment of patients with advanced RCC, after a publication of a randomized phase 3 trial , showing pazopanib having a clear benefit compared to placebo in progression free survival (PFS). Other trials, such as the COMPARZ  and PISCES  compared pazopanib to sunitinib, showing that pazopanib had non-inferior efficacy and improved quality of life. Furthermore, patients and physicians preferred pazopanib over sunitinib. 
ASCO 2018: Role of Surgery in Management of High-Risk Renal Cell Cancer
Chicago, IL (UroToday.com) In this two part educational session, Drs. Rini and Kim discuss the role of peri-operative systemic therapy for localized renal cell carcinoma. Dr. Kim discussed the role of surgery in the management of high-risk localized RCC.
Some of the data he touched upon overlapped with Dr. Rini’s talk, so it will not be repeated here. I highlight some of the important points he makes from his talk specifically.