|The following article features coverage from the 2020 Genitourinary Cancers Symposium meeting. Click here to read more of Renal and Urology News’ conference coverage.|
SAN FRANCISCO—Ipilimumab plus nivolumab has clinical efficacy in the treatment of metastatic renal cell carcinoma (mRCC) with brain metastases, including beyond the first-line setting, according to investigators presenting at the 2020 Genitourinary Cancers Symposium.
“Patients with brain metastasis were excluded from Checkmate-214 and other randomized controlled trials [of these medications], so this is an understudied population that warrants further investigation,” Landon Carter Brown, MD, of Duke University told Renal & Urology News. “Brain metastasis has been estimated to occur at a 5-year cumulative incidence of 9.8% in mRCC.”
Of 19 patients (26% female) treated at the Duke Cancer Institute in Durham, North Carolina, and Cleveland Clinic during 2017 to 2019, 68% received the monoclonal antibodies ipilimumab plus nivolumab as first-line treatment and 32% as subsequent therapy. Three-quarters of patients had clear cell histology and 16%, 58%, and 26% had favorable-, intermediate-, or poor-risk disease, respectively, according to International Metastatic RCC Database Consortium (IMDC) criteria. Most patients (84%) also received local, central nervous system (CNS)-directed therapy, including radiation therapy with or without surgery.
The objective radiographic response (ORR) rate was 42%, in line with prior research, with 29% achieving stable disease and 24% progressive disease as their best response, Dr Brown reported. Three of the 6 patients receiving ipilimumab plus nivolumab as second-line or greater therapy experienced partial response. Median time on therapy was 4.2 months.
Sixty-three percent of patients experienced an immune-related adverse event (AEs). Of those who discontinued treatment, 42% did so due to disease progression and 16% due to AEs. Three patients remain off therapy without progression.
The investigators could identify no significant predictors of partial response, stable disease, or progressive disease among the demographic and clinical variables assessed, including gender, age at diagnosis, IMDC risk, histology, presence of bone metastasis, line of therapy, number of prior therapies, or occurrence of an immune-related AE.
“This cohort study suggests that ipilimumab and nivolumab has clinical efficacy in patients with brain metastasis, but local therapy remains a critical component in treatment,” Dr Brown told Renal & Urology News. “Further investigation in this population is warranted to evaluate predictors of resistance and response to immune-checkpoint inhibitors.”
Read more of our coverage of the 2020 Genitourinary Cancers Symposium by visiting the conference page.
Brown L, Desai K, Kao C, et al. A multicenter retrospective study to evaluate real-world clinical outcomes in patients with metastatic renal cell carcinoma (mRCC) and brain metastasis treated with ipilimumab and nivolumab. Presented at the 2020 Genitourinary Cancers Symposium held February 13 to 15 in San Francisco. Poster and abstract 637.