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Over the past 2 years, the use of combination therapies for the first-line treatment of metastatic renal cell carcinoma (RCC) has become the standard of care for these patients. The first combination was nivolumab plus ipilimumab, which demonstrated a survival benefit over sunitinib in patients with intermediate and poor risk metastatic RCC (CheckMate-214). Shortly after, two immunotherapy-targeted therapy combinations were approved, demonstrating superiority of avelumab and axitinib and pembrolizumab and axitinib, compared to sunitinib in metastatic RCC.
At this year’s European Society of Medical Oncology (ESMO) Virtual Congress, Dr Regan from the Dana Farber Cancer Institute in Boston, USA presented long-term data (42 months) from the CheckMate-214 trial comparing nivolumab and ipilimumab to sunitinib, with a focus on treatment-free survival with and without toxicity.
Previous studies have shown that patients may have long periods of disease control without having to take anti-cancer treatment; however, they may also experience side effects during this time. This study looked into this effect in more detail. The researchers used data from the CheckMate-214 study, which compared the nivolumab/ipilimumab combination to sunitinib in 1096 patients with advanced clear cell renal cell carcinoma (RCC).
After 42 months of follow-up, 56% of patients on nivolumab/ipilimumab and 47% of on sunitinib were alive with 13% and 7%, respectively, remaining on their original therapy. Thirty one percent (31%) of patients on nivolumab/ipilimumab and 12% of on sunitinib were surviving free of subsequent, second line therapy.
Treatment-free survival was higher for patients who were randomised to receive nivolumab/ipilimumab (7.8 months) than those randomised to sunitinib (3.3 months). Treatment-free survival without toxicity was 7.1 months and 3.0 months, respectively. This effect was seen regardless of disease risk (favourable, intermediate or poor).