Nivolumab and Ipilimumab Combination Found Superior to Sunitinib in Renal Cell (Kidney) Cancer

In advanced kidney cancer, nivolumab plus ipilimumab was found to significantly prolong survival compared with suntinib.

Targeted drugs are standard first-line treatment for inoperable advanced clear-cell kidney cancers. In recent years, successful results with immunotherapies have led to, in second-line renal cell cancer treatment, approval for immunotherapies . Following these advances, immunotherapy studies, particularly combinations of immunotherapies , produced promising preliminary results, and testing began to determine whether they could precede targeted drugs. This article shares the first study in this area with reported results.

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In April 2018, NEJMpublished CheckMate 214, a clinical studycomparing the targeted drug sunitinib (brand name Sutent) with the complementary immunotherapy combination nivolumab (Opdivo) and ipilimumab (Yervoy). Nivolumab plus ipilimumab significantly prolonged overall survival among intermediate- and poor-risk kidney cancer patients. These successful results were featured on news sites worldwide.

The study enrolled patients from 28 countries with advanced clear-cell kidney cancer, a total of 1.096 patients, between October 2014 and February 2016. Sunitinib was given to 550, while the remainder received combination immunotherapy. In the nivolumab + ipilimumab group, 334 were intermediate-risk and 91 poor-risk. In the sunitinib group, 333 were intermediate-risk and 89 poor-risk.

Study Results:

• Among poor-risk patients, the 1-year survival rate was %80 with nivolumab + ipilimumab versus % 72 with sunitinib.
• The rate of disease regression with treatment (objective response rate) was % 42 versus % 27.
• Complete disappearance of disease with treatment, or radiological complete response , occurred at rates of % 9 versus % 1. A complete response in nearly one of every 10 poor-risk patients was particularly encouraging.
• In the analysis including all patients, 1-year overall survival was % 83 versus % 77. Overall response rates were statistically superior at % 39 versus % 32.
• While the immunotherapy combination produced superior response and survival rates in intermediate- and high-risk patients, it was not superior to sunitinib in low-risk patients.
• In the group with PD-L1 above %1, the immunotherapy combination was associated with one-third more patients alive at 1 year.
• Although the two treatments have different side effects, these appear manageable.
• What Are the Side Effects of Immunotherapy Drugs, and How Are They Treated?

In conclusion, the study achieved greater success with combination immunotherapy among newly diagnosed intermediate- and poor-risk patients with advanced clear-cell kidney cancer.

These results have opened the way to studies of combination immunotherapy in the near future, particularly in intermediate- and high-risk groups. We will follow developments for you.

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