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First-line treatment of advanced/metastatic RCC

ESMO 2020
Both CheckMate 9ER and COSMIC-021 showed efficacy of first-line combination therapy with an immune checkpoint inhibitor and tyrosine kinase inhibitor (TKI). In addition, the BIONIKK trial suggests that a 35-gene signature could be helpful to select the optimal first-line treatment in renal cell cancer (RCC). Both nivolumab and cabozantinib are approved as single agent therapies for treatment of patients with advanced clear cell RCC, based on improvements in overall survival (OS) in phase 3 clinical trials [1,2]. CheckMate 9ER evaluated first-line treatment with the combination of nivolumab and cabozantinib [3]. In this phase 3 trial, 651 patients (22.6% favourable risk, 57.6% intermediate risk, 19.7% poor risk; 24.9% PD-L1 ≥1%) were 1:1 randomised to nivolumab (240 mg every 2 weeks plus cabozantinib (40 mg daily), or sunitinib (50 mg daily for 4 weeks on/2 weeks off). Primary endpoint is progression-free survival (PFS). Secondary endpoints are OS, objectiv...

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