Each meeting of the American Society of Clinical Oncology (ASCO) serves as a touchstone for future directions, at least for a year until the next Scientific Sessions present new data on the march toward a cure. The 2015 sessions were no exception, giving us yet another opportunity to view progress through the prism of updated results. Optimization of targeted agents and novel immune checkpoint blockers remain a large focus for all of us engaged in the management of renal cell carcinoma (RCC). The new results from the meeting provide more important insights on this approach to treatment and determining which patients are likely to benefit, based on biomarker findings.
Overall, however, to what extent will the findings presented at ASCO translate into clinical practice? Although there were no “milestones” reached at this meeting—a term often used erroneously by the consumer media—there were many presentations that could be considered “stepping stones” to the major advances in therapy providers are anticipating. For example, there were encouraging results from a phase 2 three-arm study of lenvatinib and everolimus. Lenvatinib is a VEGFR1 TKI inhibitor, and it also inhibits FGFR1 and PDGFR-α, RET, and KIT TKI. About 50 patients were in each arm, and progression-free survival with the combination of lenvatinib and everolimus seemed to be significantly prolonged; it was 14.6 months for the combination, 7.4 months with lenvatinib alone, and 5.5 months with everolimus alone. We look forward to seeing a phase 3 trial that will definitely provide additional information.
The role of immune checkpoint inhibitors targeting the PD-1/PD-L1 pathway has been of special interest. Our group presented some interesting prospective biomarker analysis regarding the use of nivolumab in metastatic RCC. Our data suggest provide potential insights into what biomarker might predict response to immune checkpoint inhibitors and why potentially a combination of two immune checkpoint blockers might be better than one Other studies like RECORD-4 discussed the clinical benefit of everolimus post-TKIs or cytokines.
These results offer just a tantalizing preview of what the report in this issue of the Kidney Cancer Journal covers. Please see this report for essential information on a broad spectrum of topics related to this year’s ASCO meeting. Although information from the ASCO sessions will serve as a benchmark for future developments, there are a myriad of related issues not explored at this year’s meeting. One of these is the use of surveillance guidelines and their adequacy in detecting recurrences of RCC. The report in this issue focuses on the extent to which these guidelines from two major scientific groups need to be reconsidered in view of their limitations in predicting the rate of recurrences of metastatic RCC. This is still clearly a work in progress, and we are likely to see new recommendations within the next year as these protocols are revisited and suggestions are made for their update to reliably detect the likelihood of recurrent RCC.
Toni Choueiri, MD, Guest Editor
Clinical Director, Lank Center for Genitourinary Oncology
Director, Kidney Cancer Center
Senior Physician, Dana Farber Cancer Institute
Associate Professor of Medicine, Harvard Medical School