ESMO 2023: RENOTORCH Assesses Toripalimab and Axitinib in RCC

A roundtable discussion, moderated by Brian Rini, MD, addressed considerations for clear versus nonclear cell kidney cancer, as well as recent data from ESMO 2023. Dr. Rini was joined by Tian Zhang, MD; David McDermott, MD; and Hans Hammers, MD.

In the next segment of the roundtable series, the panel reacts to the RENOTORCH study presented at ESMO and compares the frontline doublet treatment options for clear cell RCC.

Watch the next segment in this series.

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Dr. Rini: There were some data updates at ESMO with the RENOTORCH study and then we’ll go backward, then we’ll go back to ASCO. So Tian, you and I met with some Chinese investigators at ESMO. RENOTORCH was a study of toripalimab plus axitinib versus sunitinib. Toripalimab is a PD-1 inhibitor that’s produced in China. It showed results that I thought were very axitinib/pembrolizumab-like at probably a similar stage of maturity. I don’t remember the median follow-up, but it was somewhere in the year to year and a half range. Any thoughts on that data and implications?

Dr. Zhang: I don’t think it was surprising. The first VEGF/IO [immunotherapy] combination done in a careful setting and controlled in China, so it was not surprising that it showed a progression-free survival benefit. I think it’s meaningful for the Chinese population to have access to that. It’s their first controlled study that in China they really didn’t have access to many of the frontline IO doublet trials. Not surprising, but it was a good result I think for the Chinese population to have access now to a VEGF-/IO approach. I hope that the combination will go up for registration with the Chinese FDA.

Dr. Rini: It’s a big chunk of patients given the population on the global scale.

Dr. Zhang: Absolutely.

Dr. Rini: David, do you want to say…?

Dr. McDermott: I agree. I think they discussant at ESMO did a great job of talking about the global impact of kidney cancer and how many lives would be affected, not just in China, but hopefully in other places. To me, that’s one of the discouraging things about the last 10 years is we’ve developed these exciting drugs, but the percentage of people in the world who can access them is too limited. This will make a big difference for large group. Hopefully it’ll help other people because, Tian, you were talking about just the cost in China being so much less. If that can be circulated to other places, it’s much more feasible to imagine other countries accessing it.

Dr. Zhang: Interestingly, their PD-1 production is pretty high, and the cost of PD-1 in China is low. I think they have been taking our data from non-Chinese-run trials and extrapolating that. Many of these patients probably had some access to off-label generic combinations, but now they have the control data to then say this is the right combination for those patients.

Dr. Rini: Hans, now that we have 4 IO/TKI [tyrosine kinase inhibitor] trials that have shown survival, does that make you want to give IO/TKI more? It’s 4 versus 1 because there’s only 1 ipilimumab/nivolumab trial.

Dr. Hammers: No, it’s just crowding the room. You have to stick with the truth, right? No, the thing is, I think it depends on where you are and how busy you can be with your patient. I think to me, to be honest with you, IO/TKI has become a regimen of convenience. Because you have a scared patient in the office for the very first time, and if you talk about 40% response rates versus 70% response rates, they only hear the 70%; they don’t hear the rest. They don’t hear the 5-year PFS [progression-free survival] rates. It’s actually work to convince a patient to go on an IO doublet versus an IO/TKI. Just from their perspective, you have to explain the numbers and why the TKI component is just palliative in nature. I think that’s the work.

But if you’re in private practice, if you go with, let’s say a very popular regimen like cabozantinib/nivolumab, cabozantinib is dose reduced because of the liver toxicity, so you’re already starting at a point where most patients end up with; you don’t have to do much titration of the cabozantinib. You’re not going to be too busy with the immune-related adverse events because you’re just giving half immunotherapy, just the PD-1 inhibitor. It’s a very convenient regimen for high throughput practices. That’s how I see it.

Dr. Rini: I think that’s right, especially if you’re seeing 5 to 7 patients a year and you’re not knee-deep in it like we all are.