Adjuvant RCC Treatment Considerations and Final Thoughts on RCC Therapy

A roundtable discussion, moderated by Brian Rini, MD, of the Vanderbilt-Ingram Cancer Center, focused on treatment considerations for frontline and refractory renal cell carcinoma, including a discussion of new data presented at ASCO 2023. Dr. Rini was joined by a panel that included Tian Zhang, MD; Pedro Barata, MD; and Michael Atkins, MD.

In the last segment of the roundtable series, the panel provides their concluding thoughts on the frontline and refractory RCC treatment landscape.

Watch more roundtable series.

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Dr. Atkins: With regard to adjuvant therapy, there’s some interesting data that’s come out of neoadjuvant data in melanoma suggesting that immune therapy, given when there’s a lot of T cells around in the tumor, works better than after you’ve done a resection and there’s no measurable disease. Then there’s data from the personalized cancer mRNA vaccine in melanoma, which suggests that if you increase the number of T cells around by giving vaccination together with pembrolizumab in the adjuvant setting, it does better than pembrolizumab alone. I think we have ample evidence in kidney cancer that we’re not getting as much benefit as we thought from giving treatment in the adjuvant setting in terms of activating the immune system. Maybe because we don’t have enough T cells around to activate and kill the tumor, we could still give anti-PD-1 in patients who’ve progressed on adjuvant therapy when they have more T cells around that could potentially treat the tumor.

Dr. Rini: Again, I don’t know if there’s going to be other trials to answer this. We have CONTACT-03 flatly negative, TiNivo we’ll see. I don’t think any of us would predict that it’s going to be wildly positive, if you would.

Dr. Zhang: That’s where the real-world outcomes and things like Odyssey that we track over time, things like the International Metastatic RCC Database Consortium (IMDC) database will really help us inform sequential use and how these patients are doing over time. No cooperative group is going to follow those patients through three lines of therapy. I wish they would, but real-world data will help us.

Dr. Rini: Appreciate all; this has been a really interesting discussion. Again, I feel like we could probably talk here all day about this. I think just to summarize, we have important immunotherapy (IO)/tyrosine kinase inhibitor (TKI) longer-term follow up. I think it probably introduces some questions around durability. I don’t think any of us said it was going to widely change our practice and don’t necessarily think it’s going to change community oncologists.

Dr. Atkins: But I did say it should change your practice.

Dr. Rini: I don’t entirely disagree. This is why it’s super important to have these follow-up presentations and publications and these discussions. Then in the second-line setting CONTACT-03, probably the most practice impacting data, even though negative. Negative studies can be really important. This is one, because it was happening and it doesn’t ask and answer every question. PD-1 inhibitors, time since prior therapy, etc. that we outlined. But I think it really should put to an end that practice of sequential immunotherapy as it was given in the trial. Leaving aside the far away from adjuvant or other things. Thank you all for joining us. It’s been interesting discussion.