112 patients had tumors with sarcomatoid features (sRCC) in CheckMate 214. Baseline characteristics are shown below.
Sixty patients received ipi/nivo and 52 patients received sunitinib. 50% of sRCC had tumor PD-L1 expression ≥1% at baseline, which was almost twice as many patients compared to non-sRCC.
Patients with sRCC had significant higher ORR with ipi/nivo than with sunitinib (56.7% vs 19.2%, p<0.001) and the complete response rate was 18.3%.
Median overall survival was also improved, 31.2 months vs. 13.6 months (HR 0.55, p<0.001).
In terms of adverse events (AEs), the typical AEs associated with ipi/nivo were seen in the sarcomatoid group. The most common AEs were fatigue, diarrhea, nausea, pruritus, rash, and arthralgia.
For patients with mRCC with sarcomatoid features, Ipi/Nivo has an impressive complete response (CR) rate of 18.3%. The tumors in this population seem very sensitive to immune checkpoint inhibition, with a CR rate of 10% seen with pembrolizumab/axitinib. It is unknown which frontline therapy best balances toxicity with efficacy and at this time, both treatments are reasonable options for patients with mRCC with sarcomatoid features. Additional biomarker work is necessary to see if we can predict which patients respond better to dual CPI blockade vs. TKI/CPI blockade.
Presented by: David F. McDermott, MD, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
Written by: Jason Zhu, MD. Fellow, Division of Hematology and Oncology, Duke University, @TheRealJasonZhu, at the 2019 ASCO Annual Meeting #ASCO19, May 31- June 4, 2019, Chicago, IL USA
- Motzer RJ, Tannir NM, McDermott DF, et al. Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma. New England Journal of Medicine 2018;378:1277-90.
- Tannir NM, Frontera OA, Hammers HJ, et al. Thirty-month follow-up of the phase III CheckMate 214 trial of first-line nivolumab+ ipilimumab (N+ I) or sunitinib (S) in patients (pts) with advanced renal cell carcinoma (aRCC). American Society of Clinical Oncology; 2019.