In recent years, drugs that target the vascular endothelial growth factor (VEGF) pathway, such as Sutent (sunitinib), Votrient (pazopanib), Nexavar (sorafenib), Inlyta (axitinib) and Avastin (bevacizumab), have been successful at improving the life expectancy of patients with metastatic renal cell carcinoma (RCC).
However, for many patients anti-VEGF therapy fails and their disease eventually progresses. Immunotherapies, such as PD-1/PD-L1 inhibitors, have emerged as a valuable alternative to VEGF inhibitors as a second-line treatment. The PD-1 inhibitor Opdivo (nivolumab) was recommended by the National Institute for Health and Care Excellence (NICE) for use within NHS England and Wales in November 2016 as a treatment for patients with metastatic RCC following prior targeted (antiangiogenic) therapy. The approval was based on findings from the phase 3 CheckMate-025 trial, in which Opdivo improved median overall survival by 5.4 months compared to Afinitor (everolimus).
The next step to build on this success with anti–PD-1/PD-L1 treatment is a combination of an immunotherapy drug with a VEGF inhibitor as a first-line treatment for metastatic RCC. The following articles discuss the future of combination therapies for the treatment of advanced kidney cancer: