Renal cell cancer (RCC) is responsible for 3.7 % of all cancers\u00a0diagnosed yearly and is ranked as the third most common\u00a0urological cancer in the US population. The average\u00a0age at diagnosis is 64 years old and one third of patients\u00a0present with metastatic disease. It is a disease that is\u00a0usually resistant to conventional chemotherapy and radiotherapy, and the\u00a0current standard of treatment is based on tyrosine\u00a0kinase inhibitors (TKIs) and mammalian target of rapamycin\u00a0(mTOR) inhibitors. These agents are associated with an improvement in PFS and OS but at the expense of a significant\u00a0rate of AEs that are poorly tolerated by patients. This problem\u00a0is more significant in older adults who often have a decreased\u00a0performance status and may suffer from multiple\u00a0comorbidities.<\/p>\n
Efficacy of immune mediated therapies<\/a> in the treatment of\u00a0RCC was established in the early 1990s with the approval of\u00a0high-dose interleukin-2 (IL2). In 1995, Fyfe et al. Reported\u00a0positive outcomes with the use of high-dose IL2 in patients\u00a0with metastatic RCC. A response rate of 14 % was achieved\u00a0although this was at the expense of a high rate of treatmentrelated toxicity. Checkmate-025 explored the role of\u00a0nivolumab in the second line treatment of patients with metastatic RCC who progressed on previous antiangiogenic therapy. Patients were randomized to 3 mg\/kg of nivolumab intravenously every 2 weeks or everolimus tablet 10 mg orally\u00a0daily. Nivolumab demonstrated superiority to everolimus with a median OS of 25.0 months (95 % CI, 21.8- not\u00a0reached) compared to 19.6 months, HR for death in the general study population of 0.73 (98.5 % CI, 0.57\u20130.93), and an\u00a0overall response rate of 25 versus 5 % with everolimus.\u00a0Nivolumab was also associated with lower rates of grade 3\u2013\u00a04 AEs (19 vs 37 %). There was no difference in survival\u00a0benefit or response rates based on the degree of PD-L1<\/a> expression. Efficacy analysis based on age showed a HR of 0.64\u00a0(95 % CI, 0.45\u20130.91) in patients aged 65 to 75 years compared\u00a0to 1.23 (95 % CI, 0.66\u20132.31) in those older than 75. However,\u00a0no real conclusions can be drawn from these numbers. Out of\u00a0the 821 patients enrolled in this trial, 39 % were older than\u00a065 years but only 9 % were older than 75 years. Dual check\u00a0point inhibition with nivolumab and ipilimumab is being compared to sunitinib monotherapy.\u00a0This trial expects to randomize about 1070 treatment-na\u00efve patients stratified by\u00a0International mRCC Database Consortium prognostic score\u00a0and by region. The primary endpoints will be PFS and OS,\u00a0secondary endpoints include ORR and safety. Currently,\u00a0nivolumab in metastatic RCC is the only approved indication\u00a0for a checkpoint inhibitor in genitourinary malignancies.<\/p>\n <\/p>\n Reference:<\/p>\n Rawad Elias & Joshua Morales & Yasser Rehman & Humera Khurshid. Curr Oncol Rep (2016) 18: 47<\/p>\n","protected":false},"excerpt":{"rendered":" Renal cell cancer (RCC) is responsible for 3.7 % of all cancers\u00a0diagnosed yearly and is ranked as the third most common\u00a0urological cancer in the US population. The average\u00a0age at diagnosis […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[21],"tags":[299,297,298],"_links":{"self":[{"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/posts\/508"}],"collection":[{"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/comments?post=508"}],"version-history":[{"count":1,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/posts\/508\/revisions"}],"predecessor-version":[{"id":509,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/posts\/508\/revisions\/509"}],"wp:attachment":[{"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/media?parent=508"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/categories?post=508"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/tags?post=508"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}