Dr. Grünwald on progression patterns in advanced renal cell carcinoma

In this video, Viktor Grünwald, MD, PhD, highlights the background and key findings from the abstract, “Lenvatinib plus pembrolizumab (L+P) vs sunitinib (S) in advanced renal cell carcinoma (aRCC): Patterns of progression and subsequent therapy in the CLEAR trial. Abstract #4524,” which was presented at the 2024 American Society for Clinical Oncology Annual Meeting in Chicago, Illinois. Grünwald is a professor for Interdisciplinary Genitourinary Oncology at the University Hospital Essen in Essen, Germany.

Video Transcript:

Could you recap the previously reported findings from this analysis of the CLEAR study (NCT02811861)?

The CLEAR study investigated the use of lenvatinib and pembrolizumab vs sunitinib in the first-line setting of kidney cancer patients. We did a couple of subgroup analyses in order to learn what are the groups of patients that benefit most? And what is the clinical pattern that helps guiding the choice when you make your clinical decision and that process. So, we looked into response by organ size because when you sit in front of a patient, you consider an individual patient vs the overall trial results. We figured when you know the type of tumor shrinkage that occurs in different organs, such as liver, lymph node, lung, you will learn more and you have a better understanding that specific patients really would be benefiting most.

The second part that we also analyzed was looking into whether the tumor burden at start of therapy would influence the outcome. We did not find a very strong association, but we have seen that if you have a higher tumor burden, you associate the risk features. Overall, len/pem performed quite well irrespective of the tumor burden. So, I think overall it was quite reassuring of the use of len/pem.

What were the findings presented at ASCO 2024?

Basically, what we did this time was really looking into the different types of progression, because we investigated the different organ sites, only those lesions that were treated there and counted only those progressions that occurred in the different organ sites, so meaning lungs, lymph nodes, liver, bone, CNS. So, we split this apart and looked into if the type of progression would occur differently depending on the organ sites, which it did not. What we have seen is maintained benefits for the combination of lenvatinib and pembrolizumab vs sunitinib. So, in this subset analysis, according to the progression pattern, we have seen similar results.

This transcription has been edited for clarity.