Direct comparisons of combination treatments for previously untreated, advanced kidney cancer are limited. A recent study compared the real world treatment outcomes for an immunotherapy combination, nivolumab plus ipilimumab, with two immunotherapy plus targeted therapy combinations: lenvatinib plus pembrolizumab, and nivolumab plus cabozantinib as first-line treatments for patients with previously untreated advanced kidney cancer.

The clinical data from 194 patients who were treated with nivolumab plus ipilimumab, lenvatinib plus pembrolizumab or nivolumab plus cabozantinib as first-line treatments for advanced kidney cancer were assessed in the real world.

The time to when the treatment stopped working and the cancer started growing again (progression-free survival) was longer for the patients who were treated with lenvatinib plus pembrolizumab or nivolumab plus cabozantinib (average 26 months compared to 9 months for nivolumab plus ipilimumab). More patients responded to treatment with lenvatinib plus pembrolizumab or nivolumab plus cabozantinib, than nivolumab plus ipilimumab. There was no difference in overall survival between the combination treatments.

There were more side effects and treatment interruptions in the group of patients treated with lenvatinib plus pembrolizumab, or nivolumab plus cabozantinib. However, the patients who were treated with nivolumab plus ipilimumab needed more steroid treatment.

In conclusion, lenvatinib plus pembrolizumab, or nivolumab plus cabozantinib had better survival outcomes and response to treatment compared to nivolumab plus ipilimumab, but were not as well tolerated. This study will help to provide optimal and individualised treatment options for patients with advanced kidney cancer.

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