Metastatic kidney cancer: a new standard of treatment

A combination of immunotherapy and targeted therapy may be more effective in the fight against advanced kidney cancer, according to two new studies presented at ASCO-GU.

Two new separate studies published Saturday, February 16 in the New England Journal of Medicine presented at the ASCO-GU 2019 congress bring encouraging results in the treatment of metastatic kidney cancer.

The first study is a Phase 3 clinical trial conducted by the Dana-Farber Cancer Institute (Boston, USA). It shows that the combination of immunotherapy with avelumab, combined with targeted treatment with axitinib (anti-VEGF), could become a new standard in first-line treatment in patients with metastatic renal cancer.

Decreased tumors

The work involved 886 patients with kidney cancer. Of these, 442 received avelumab (an anti-PD-L1 immunotherapy) and axitinib as treatment, and 444 received sunitinib, a first-generation anti-VEGF for the treatment of metastatic kidney cancer.

Patients who received the combination had a significant advantage in progression-free survival compared to those treated as monotherapy. The study showed that mean progression-free survival was 13.8 months in patients treated with avelumab and axitinib, compared to 7.2 months in those treated with sunitinib.

"Patients receiving the combination also have a higher response rate - which means that their tumors have decreased - compared to the group receiving only sunitinib," said Toni K. Choueiri, MD, lead author of the research. appeared in the New England Journal of Medicine.

47% less risk of death

The second study, also published in the NEJM, tested two modes of treatment on a cohort of 861 patients with kidney cancer: the first with a combination of pembrolizumab (anti-PD-L1 immunotherapy) and axitinib and the second with suninib only.

Of the patients who participated in the study, 432 received intravenous pembrolizumab and axitinib as treatment, and 429 received sunitinib. The results show that the mean progression-free survival of the disease is 15.1 months in the pembrolizumab-axitinib group compared with 11.1 months in the sunitinib-treated patients.

Patients who received the combination treatment pembrolizumab-axitinib therefore have a 47% lower risk of death and a 31% lower risk of disease progression than those who received sunitinib.

More research is needed

These two studies therefore have similar results, namely that combination therapies significantly improve the chances of survival and halt progression of the disease more than monotherapy. This new lead is therefore promising, even though the combined treatments tested in these two studies are not yet approved by the Food and Drug Administration for renal cell cancer.

For Dr. Bernard Escudier, former president of the genitourinary group of the Institut Gustave Roussy in France, who published an editorial in the NEJM about these 2 new jobs: "These two combinations should become new standards of care and be incorporated into future guidelines."

It remains to be seen whether the effectiveness of these treatments is confirmed in the long term. Experts stress the need to follow patients for longer, as well as to conduct more in-depth research on the global way that immunotherapies influence therapeutic approaches.

Video: Cancer Research: Immunotherapy combination shows promise in kidney cancer (February 2020).