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The results of an analysis of renal cell carcinoma (RCC) patients with brain metastases that were not causing any symptoms (asymptomatic metastatses) from the phase 2 GETUG-AFU 26 (NIVOREN) clinical trial were presented at the European Society of Medical Oncology (ESMO) 2018 Congress in Munich last week.
The GETUG-AFU 26 (NIVOREN) trial looked at the real-world efficacy of nivolumab in patients who have progressed on VEGF-targeted therapy in the first-line. Brain metastases result in a worse prognosis for patients with metastatic RCC. These patients are typically treated with stereotactic radiotherapy or surgery, since targeted therapies have poor success against brain metastases. This study, therefore, investigated the efficacy of nivolumab, an immune checkpoint inhibitor in this patient population, which was a subset of the larger prospective phase 2 GETUG-AFU 26 (NIVOREN) trial.
To be included in the analysis, brain metastases had to be asymptomatic with no surrounding oedema, and did not need treatment with steroids, surgery or radiotherapy at the time of study entry.
The researchers concluded that the efficacy of nivolumab was poor against asymptomatic brain metastases that had not previously been treated with surgery or radiotherapy, and most patients eventually required local treatment (surgery or radiotherapy) for progression of the brain metastases. Patients receiving nivolumab should receive local therapy for brain metastases prior to systemic therapy.