A roundtable discussion, moderated by Monty Pal, MD, of the City of Hope, focused on updates in renal cell carcinoma (RCC), including treatment in both the frontline and adjuvant settings. Dr. Pal was joined by a panel that included Daniel George, MD; Brad McGregor, MD; and Cristina Suárez Rodríguez, MD.
In the next segment of the roundtable series, the panel discusses outcomes from the CheckMate-9ER trial presented at ASCO 2022 and addresses the importance of depth of treatment response.
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Dr. Pal: Cristina, you had some really beautiful data at ASCO last year related to depth of response. I really liked that. Could you share that with us and go through that?
Dr. Suarez: We presented data about depth of response and the relationship with outcomes in the CheckMate-9ER trial. What we found out was that more patients had deeper responses in the nivolumab/cabozantinib arm than in the sunitinib arm. In both arms, but especially the relationship was even more linear in the nivolumab/cabozantinib arm, there was a direct relationship with progression-free survival (PFS) and with overall survival (OS). Patients with deeper responses had better PFS, better OS, and like 80%, it was more or less like having a complete response. For me, response is important.
Dr. George: Does it matter how you get there? Like if it’s just the drug alone getting you that depth of a response, or if you add a little radiation therapy or debulking nephrectomy or something else?
Dr. Suarez: We didn’t check in the trial. We don’t have this data.
Dr. Pal: I actually lean on this data every now and then with patients in the clinic. Because you run into patients, obviously their goal is to eradicate their disease completely, they want that complete response. Where I find your data so helpful is for that patient who really achieves that deep response. I think you called it a partial response 1 in your trial: 80% to almost 100%. They’re almost there and their outcomes are outstanding, almost unparalleled with what complete response might be.
Dr. George: Is this going to be the tail of our curve that Brad is referring to?
Dr. Pal: I think that might be it.
Dr. Suarez: Yeah. I have even patients with these responses that I had to stop; for example, I have 1 patient that I had to stop cabozantinib because of toxicity, and he’s without treatment for 2 years, and his response is maintained. He’s without treatment now. These deep responses, I think they’re of a good quality response.
Dr. George: What’s the timing of these deep responses? When do you see them? Do you keep seeing these things all the way out to 2 years?
Dr. Suarez: Usually, yes. We don’t have the numbers, but I don’t know in your experience, but when a patient has a very, very good response, it’s like long response.
Dr. George: Yeah. I’ve seen patients where I’m doing scans, I’m still seeing some decreases, all the way out. It may not be a lot of percentage, but patients still a year-plus out and the tumor is still shrinking. It’s kind of remarkable when you think about this.
Dr. Suarez: After some CT scans with the stable disease and then go down again.
Dr. George: And you know what? Everybody loves that.
Dr. Suarez: Yeah. I’m very surprised when I found that on the patients as well.
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