Dr. Jeffrey Graham on frontline immunotherapy in non–clear cell RCC

Jeffrey Graham, MD, discusses study results shared during the 2021 Genitourinary Cancers Symposium which suggest that for patients with the rare histology of non–clear cell renal cell carcinoma (RCC), frontline immune checkpoint inhibitor therapy could improve overall survival (OS).

The study showed that in a population of 1181 patients with non–clear cell metastatic RCC, the median OS was 28.6 months in patients receiving an immune checkpoint inhibitor–based regimen compared with 19.2 months and 12.6 month, respectively, in patients being treated with a VEGF inhibitor and an mTOR inhibitor.

The median time-to-treatment failure in those who received an immunotherapy-based regimen was also longer at 6.9 months versus 5.1 months with a VEGF inhibitor and 3.9 months with an mTOR inhibitor.

In the entire population of patients included in the analysis, the objective response rate (ORR) achieved in those who received an immunotherapy-based regimen was 25%; it was 17.8% in those who received VEGF targeted therapy and 5.8% in those who received mTOR-targeted treatment.

When looking at ORR per histologic subgroup, those with papillary disease who received VEGF treatment experienced an ORR of 13.0% versus 3.7% with mTOR therapy and 31.6% with immunotherapy-based treatment. In patients with the chromophobe subtype, the ORRs were 20.6% versus 13.6% versus 9.1% in those who received VEGF therapy, mTOR therapy, and an immunotherapy-based regimen, respectively. Those with an unclassified disease subtype experienced ORRs of 15.2%, 0%, and 33.3%, respectively.

Graham is a medical oncologist and an assistant professor at the University of Manitoba in Canada.