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Expert Point of View: Toni K. Choueiri, MD


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At the Genitourinary Highlights session of the ASCO20 Virtual Scientific Program, Toni K. Choueiri, MD, Director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, Boston, put these findings into perspective. “This is an important update. The initial publication was with a follow-up of 7 months. At that time, the hazard ratio for overall survival was 0.53 and for progression-free survival, 0.69. With 23 months of follow-up, the hazard ratio for overall survival went up to 0.68, and progression-free survival stabilized. The complete response rate was 9%,” he said. “There were no new emerging safety signals with pembrolizumab plus axitinib.”

Other trials are comparing an immune checkpoint inhibitor plus a VEGF inhibitor and also an immune checkpoint inhibitor plus an immune checkpoint inhibitor vs sunitinib.

Toni K. Choueiri, MD

Toni K. Choueiri, MD

Questions Remain

The results of KEYNOTE-426 bring up the question of whether two drugs are needed in patients with favorable-risk disease, continued Dr. Choueiri. “Should we consider the long-term toxicities of two drugs vs one drug?”

Three other ongoing phase III trials are comparing combinations vs sunitinib, he added. Investigational combinations include lenvatinib plus everolimus or pembrolizumab and cabozantinib plus nivolumab. The COSMIC 313 trial will evaluate nivolumab plus ipilimumab with or without cabozantinib.

Another area of study is the need for continuing checkpoint inhibitor therapy after disease progression in metastatic renal cell carcinoma. “Keep an eye on the next generation of trials,” Dr. Choueiri told the audience. 

DISCLOSURE: Dr. Choueiri owns stock or other ownership interests in Pionyr and Tempest; has received honoraria from Alexion Pharmaceuticals, Alligent, Analysis Group, ASCO, AstraZeneca, Bayer, Bristol-Myers Squibb, Cerulean Pharma, Clinical Care Options, Corvus Pharmaceuticals, Eisai, EMD Serono, Exelixis, Foundation Medicine, Genentech/Roche, GlaxoSmithKline, Harborside Press, Heron, Ipsen, Kidney Cancer Journal, The Lancet Oncology, Lilly, Lpath, Merck, Michael J. Hennessy Associates, Navinata Healthcare, the National Comprehensive Cancer Network, The New England Journal of Medicine, Novartis, Peloton Therapeutics, Pfizer, PlatformQ Health, Prometheus, Sanofi/Aventis, and UpToDate; has served as a consultant or advisor to Alexion Pharmaceuticals, Alligent, Analysis Group, ASCO, AstraZeneca, Bayer, Bristol-Myers Squibb, Cerulean Pharma, Clinical Care Options, Corvus Pharmaceuticals, Eisai, EMD Serono, European Society for Medical Oncology, Exelixis, Foundation Medicine, GlaxoSmithKline, Harborside Press, Heron, Ipsen, Kidney Cancer, The Lancet Oncology, Lilly, Lpath, Merck, Michael J. Hennessy Associates, Navinata Healthcare, the National Comprehensive Cancer Network, The New England Journal of Medicine, Novartis, PlatformQ Health, Peloton Therapeutics, Pfizer, Prometheus Laboratories, Roche/Genentech, Sanofi/Aventis, and UpToDate; has received institutional research funding from Agensys, Analysis Group, AstraZeneca, Bayer, Bristol-Myers Squibb, Calithera Biosciences, CDMRP/ DOD, Celldex, Cerulean Pharma, Corvus Pharmaceuticals, Eisai, Exelixis, Foundation Medicine, GATEWAY for Cancer Research, GlaxoSmithKline, Ipsen, Merck, the National Cancer Institute, Novartis, Peloton Therapeutics, Pfizer, Prometheus, Roche, Roche/Genentech, Seattle Genetics/Astellas, Takeda, and Tracon Pharma; holds a patent entitled “Biomarkers of Clinical Response and Benefit to Immune Checkpoint Inhibitor Therapy” and a patent entitled “PBRM1 Biomarkers Predictive of Anti-immune Checkpoint Response”; has been reimbursed for travel, accommodations, or other expenses “in relation to consultancy/ad boards”; and has held other relationships with ClinicalThinking, Envision Pharma Group, Fishawack Group of Companies, Health Interactions, and Parexel.


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