Updated guidelines from the European Association of Urology consider immune checkpoint inhibition with pembrolizumab plus axitinib or ipilimumab plus nivolumab to be a new standard of care for the first-line treatment of metastatic clear-cell renal cell carcinoma (RCC).
According to the guidelines, which appear in an article published in European Urology by Laurence Albiges, MD, of Gustave Roussy, Université Paris-Saclay, Villejuif, France, and colleagues, EAU recommends that physicians offer pembrolizumab plus axitinib to treatment-naïve patients with any IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) risk disease and ipilimumab plus nivolumab to treatment-naïve patients with IMDC intermediate- and poor-risk disease. The recommendations are based on clinical trials showing that these combinations are associated with a survival benefit in these patients. In the KEYNOTE-426 trial, the combination of pembrolizumab and axitinib was associated with a significant 47% decreased risk of death compared with sunitinib monotherapy. It also was associated with a significant 31% decreased risk of disease progression. In the Checkmate 214 trial, the combination of ipilimumab and nivolumab was associated with a significant 37% decreased risk of death compared with sunitinib monotherapy.
For patients who cannot receive or tolerate immune checkpoint inhibition, the updated guidelines recommend that physicians offer sunitinib plus pazopanib to treatment-naïve patients with any IMDC risk disease and cabozantinib to treatment-naïve patients with IMDC intermediate- and poor-risk disease.
Albiges L, Powles T, Staehler M, et al. Updated European Association of Urology guidelines on renal cell carcinoma: Immune checkpoint inhibition is the new backbone in first-line treatment of metastatic clear-cell renal cell carcinoma. Eur Urol. 2019:76:151-156. 10.1016/j.eururo.2019.05.022