Deliberations on IO as first-line therapy for kidney cancer patients

Deliberations on IO as first-line therapy for kidney cancer patients

In the point-counterpoint discussion “Immunotherapy for all patients as first line in kidney cancer?” in Plenary Session 04 “Immunotherapy: Evolving paradigms in GU cancers”, Dr. Laurence Albiges (FR) presented her insights in favour of immunotherapy (IO) as first-line treatment.

She stated that overall survival (OS) benefit with Nivolumab + Ipilimumab is the new benchmark, and pointed out that some good-risk patients can achieve complete response (CR) with IO approach. She added that given OS benefit in some of the IO-based combination is “practice changing”.

Dr. Albiges stated that to date, clinical strategy uses clinical risk classifications; but there is “much more to do to increase patient selection”.

“This debate is not about immunotherapy per se but about the timing of immunotherapy. It does not necessarily need to be the first-line treatment in all patients,” said Prof. Manuela Schmidinger (AT).

She stated that favourable-risk and some intermediate-risk patients may be better off with delayed immune-checkpoint inhibitors (ICI) as using ICI combinations too early in the course of the disease could signify a loss of opportunity.

Prof. Schmidinger said, “The worst-case scenario is if your patient does not benefit from important drugs because you simply did not use them in the right setting and at the right time,” as she referred to patients who are immunologically prepared for the drugs.

“Outcomes of targeted agents (TA) + ICI studies are somewhat disappointing, considering that this is the ‘best’ strategy ever,” stated Prof. Schmidinger. “The timing is probably wrong.” She added that the likelihood that patients would receive ICI a second time is low.

According to Prof. Schmidinger, “ICI should be used when the tumour is up to it, when the tumour is hot. Let’s make sure it’s hot beforehand.”

Plenary Session 04 was chaired by Dr. Maurizio Colecchia  (IT), Prof. Dr. Igle Jan De Jong  (NL),  Prof. S. Silke Gillessen Sommer (CH), Dr. Ananya Choudhury (GB) and Dr. Ashish Kamat (US).

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