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Nivolumab in Renal Cell Carcinoma: Current Trends and Future Perspectives
Cesar E Ochoa1, Richard W Joseph1
1Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
Abstract:
Targeted agents form the backbone of most therapeutic strategies in advanced renal cell carcinoma (aRCC) but ultimately resistance develops and toxicity often leads to discontinuation of treatment, limiting the clinical benefits of these treatments. Nivolumab, a fully human IgG4 anti-PD-1 antibody, selectively blocks the interaction between PD-1 and its ligands PD-L1 and PD-L2 and provides a novel therapy option for patients with aRCC. In 2015, the pivotal phase III study CheckMate 025 led to the Food and Drug Administration approval of nivolumab in patients with aRCC who had received prior anti-angiogenic therapy, and in 2017, the phase III study CheckMate 214 showed that combined immunotherapy with nivolumab plus ipilimumab resulted in greater objective response rate and prolonged progression-free survival when compared with sunitinib in intermediate- and poor-risk patients with previously untreated aRCC. Early studies of nivolumab in association with anti-angiogenic therapy have generated enthusiasm and multiple combination trials are ongoing.
Insights
Nivolumab offers a new treatment for advanced renal cell carcinoma (aRCC) by blocking PD-1. It has shown success in patients previously treated and in combination therapy for previously untreated patients.
Area of Science:
- Oncology
- Immunology
Background:
- Targeted agents are standard for advanced renal cell carcinoma (aRCC), but resistance and toxicity limit their effectiveness.
- Nivolumab, an anti-PD-1 antibody, offers a novel therapeutic approach by blocking PD-1/PD-L1 interactions.
Purpose of the Study:
- To review the role of nivolumab in advanced renal cell carcinoma treatment.
- To highlight the efficacy of nivolumab as a monotherapy and in combination for aRCC.
Main Methods:
- Review of pivotal phase III studies (CheckMate 025 and CheckMate 214).
- Analysis of nivolumab's efficacy in previously treated and untreated aRCC patients.
Main Results:
- Nivolumab gained FDA approval in 2015 for previously treated aRCC patients.
- CheckMate 214 (2017) demonstrated superior objective response rate and progression-free survival with nivolumab plus ipilimumab versus sunitinib in untreated intermediate- and poor-risk aRCC.
Conclusions:
- Nivolumab represents a significant advancement in aRCC therapy.
- Combination strategies involving nivolumab are promising and under active investigation.
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