A recently updated consensus statement from the Society for Immunotherapy of Cancer (SITC) recommend a combination of axitinib and pembrolizumab as initial therapy for patients with favorable-risk clear cell advanced renal cell carcinoma (aRCC), according to a report in the Journal of ImmunoTherapy of Cancer.
For patients with intermediate- or poor-risk clear cell aRCC or whose disease has a sarcomatoid component, the society recommends ipilimumab plus nivolumab or axitinib plus pembrolizumab as upfront treatment. Anti-PD-1 monotherapy is recommended as initial therapy for patients with non-clear cell aRCC. Patients were categorized as having favorable-, intermediate-, and high-risk disease based on criteria established by the International Metastatic RCC Database Consortium.
The updated recommendations, developed and presented in a position paper written by the SITC’s Cancer Immunotherapy Guidelines (CIG) Renal Cell Carcinoma Subcommittee, are based on current FDA approvals for first-line therapy. The paper includes an algorithm to guide management of patients with aRCC. Treatment decisions, however, should be made on a case-by-case basis, according to panel members.
“The final selection of therapy should be individualized based on patient eligibility and therapy availability based on the treating physician’s discretion,” Brian I. Rini, MD, of the Cleveland Clinic Taussig Cancer Center, and coauthors wrote.
The subcommittee recommends central nervous system imaging for all patients, with bone imaging considered for symptomatic patients. The subcommittee defined need for systemic therapy as the absence of low-volume, slow-growing disease. It defined candidates for immunotherapy as patients without active autoimmune conditions requiring immunosuppressive therapy or a history of potential life-threatening autoimmune conditions, or those who do not need corticosteroids to treat other conditions.
Rini BI, Battle D, Figlin RA, et al. The society for immunotherapy of cancer consensus statement on immunotherapy for the treatment of advanced renal cell carcinoma (RCC).
J Immunother Cancer. 2019;20:354.