Sumanta K. Pal, MD

ASCO EXPERT Sumanta K. Pal, MD, of City of Hope, Duarte, California, commented, “IMmotion 151 is a positive trial and represents an important breakthrough. We have debated combination treatment strategies for advanced kidney cancer. This study looks at the combination of a programmed cell death ligand 1 (PD-L1) inhibitor plus an anti–vascular endothelial growth factor agent and shows a higher response rate compared with sunitinib (Sutent). Complete response represents the highest bar, and this is where we will hang our hats. Complete response rates were 9% for the combination and 5% for sunitinib in the PD-L1–positive patients, and 5% and 2%, respectively, in the intent-to-treat treat analysis.”

He continued: “Tolerability is an important piece of the puzzle. The big difference in this trial centers on toxicity and tips the scales toward atezolizumab (Tecentriq) plus bevacizumab (Avastin). The side-effect profile compares favorably with nivolumab (Opdivo) plus ipilimumab (Yervoy), another combination studied in newly diagnosed patients. With nivolumab/ipilimumab, 60% of patients required steroids for immune-related side effects vs 16% of patients in this trial.”

Dr. Pal added, “Progression-free survival was consistently improved with the combination of atezolizumab plus bevacizumab over sunitinib in both the PD-L1–positive patients and the intent-to-treat analysis. This may allow us to get away from using PD-L1 status for triaging patients.”

When asked whether the cost of using two expensive drugs was justifiable, Dr. Pal said, “There was a compelling trend toward overall survival improvement with atezolizumab/bevacizumab, and for any benefit in overall survival, the cost is justifiable.” ■

DISCLOSURE: Dr. Pal reported no conflicts of interest.