Lori Wood, MD

Formal discussant of KEYNOTE-426, Lori Wood, MD, of Dalhousie University, Halifax, Nova Scotia, Canada, called both KEYNOTE-426 and JAVELIN-101 “practice-changing.”

“In 2019, we have a new standard of care,” Dr. Wood declared. “The majority of patients with clear cell advanced renal cell carcinoma will be eligible to receive combination therapy with a checkpoint inhibitor/axitinib. However, there are important issues to resolve, such as which treatment is better, can we afford it, and can it be safely delivered to all patients.”

Regarding which checkpoint inhibitor combination is better, Dr. Wood said, “For intermediate-/poor-risk patients, there is no clear winner between the checkpoint inhibitor/axitinib combination or the dual checkpoint inhibitor combination of nivolumab and ipilimumab.”

Words of Caution

Dr. Wood pointed out that checkpoint inhibitor combination therapy requires more time, many more visits to the clinic, and more infusions compared with the use of sunitinib.

“The decision about which combination to use may rest on overall survival, complete responses, and toxicities, as well as the practical aspects of delivering therapy, including the costs. Major infrastructure and system changes will have to be made to accommodate this new standard of care, and it probably won’t be accessible worldwide,” she stated. ■

DISCLOSURE: Dr. Wood has received institutional research funding from Bristol--Myers Squibb, Pfizer, Roche Canada, Exelixis, Merck, AstraZeneca, and Novartis; and an immediate family member has received research funding from Aragon Pharmaceuticals.