CheckMate 67T: Do Recent Updates Make This Practice-Changing?

A roundtable discussion, moderated by Katy Beckermann, MD, PhD, discussed the treatment sequencing, management, and future directions of advanced or metastatic kidney cancer, as well as relevant clinical trial data from the 2024 American Society of Clinical Oncology Annual Meeting. Dr. Beckermann was joined by Yousef Zakharia, MD; Pavlos Msaouel, MD, PhD; Benjamin Maughan, MD, PharmD; and David McDermott, MD.

In the second segment of the roundtable series, the panel highlights the potential practice-changing impact of subcutaneous PD-1 agents for kidney cancer treatment, highlighting benefits, methodological considerations, and challenges in implementation, particularly in improving patient access and safety.

View the next segment on Considerations for Managing Patients on Maintenance RCC Therapy.

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Dr. Beckermann: One of the other things we saw at the meeting earlier this year was updated information on quality of life and bio-distribution data for subcutaneous PD-1 agents. I thought we could brainstorm how this could be practice-changing, or if it will be. Many groups are developing subcutaneous injections, and the CheckMate 67T trial, a non-inferiority trial in metastatic renal cell carcinoma (RCC) patients, met its primary endpoint of being non-inferior. The updates at this current meeting showed that the quality of life was equal between the subcutaneous and IV formulations.

There was also a poster on distribution and bioavailability based on BMI, showing similar results, though the cohorts were small, making it hard to confirm this for extreme BMI categories. Let us brainstorm how this might impact your practice and patients.

Dr. Zakharia: I think utilizing subcutaneous instead of IV is great, primarily because it saves patient time; it is faster to administer. Another factor is the space in our infusion suites. Saving time for both patients and the infusion chair is a huge advantage. The non-inferiority data for subcutaneous compared to IV is reassuring. More importantly, the patient-reported outcomes (PROs) suggest no difference between the modalities. If large randomized clinical trials confirm this, it could be practice-changing due to its practicality.

Dr. Msaouel: I agree. Methodologically, many are against looking at changes from baselines in randomized trials, especially with PROs and quality of life. This trial, however, emphasized comparative inferences at specific time points, which is commendable from a methodology standpoint and not often seen in oncology.

Dr. Beckermann: Dr. Maughan, what do you think? Will you use it?

Dr. Maughan: Yes, from a practical standpoint. Our cancer center in Utah is the only major academic center in multiple states, and many patients travel hours to reach us. This could reduce the burden on our infusion center and help patients. We are also moving into better telehealth, and pairing treatment with telehealth oversight could save patients long travel times. In the Mountain West region, this is welcome news.

Dr. McDermott: Dr. Maughan makes an important point. AACR published a summary of disparities in patient outcomes, highlighting that many newer therapies do not reach all patients. Extending access to those with travel issues is great. We also need to address cost and therapy duration to make these agents more accessible. Our progress should benefit every patient to make a significant impact.

Dr. Beckermann: I wonder if we will develop new supportive networks as we expand telehealth and access. My concern is the safety of patients who are far from the site if they experience immune-related adverse events. Partnering with local medical facilities might be necessary to increase accessibility.

Dr. McDermott: That is a critical point. I think the first few doses should be administered under close supervision since most adverse events occur early. Seeing the patients initially is key. By month 6 or 12, there is usually no new issues, so extending access at that point makes sense.

Dr. Beckermann: Right. Maybe implementing safety measures upfront and recognizing stability after a certain period can help.