Giulia Claire Giudice: Strategies for RCC patients progressing on ICIs
Giulia Claire Giudice, Medical Doctor at University Hospital of Parma, shared an article on X:
“Newly published JAMA Oncology!
Deep dive into strategies for RCC patients progressing on ICIs. A comprehensive review on the latest data and emerging approaches.
Read here.
ICI Rechallenge in Melanoma and NSCLC:
- CheckMate 064: Nivolumab → Ipilimumab: better ORR & OS.
- Keynote-002: Pembrolizumab after ipilimumab showed PFS but no OS benefits.
- NSCLC: Retreating with ICIs showed some benefit, especially post-toxicity discontinuation.
Retrospective RCC Data.
Small studies show modest efficacy for ICI rechallenge in RCC:
- ORR ~23%, PFS ~5.7 months.
- Higher responses in prior responders to ICI.
Prospective Phase 2 Trials:
- KEYNOTE-146: Pembrolizumab + Lenvatinib → ORR 59%, PFS 11.6 months.
- Nivolumab + Sitravatinib: minimal benefit, trial terminated early.
- Meta-analysis of 10 trials: ORR 19%, PFS 5.6 months.
Phase 3 Trials:
- CONTACT-03: Atezolizumab + Cabozantinib ≠ better than Cabozantinib alone.
- TiNivo-2: Tivozanib + Nivolumab failed to improve PFS over Tivozanib alone.
- Suggests no clear benefit for ICI continuation in ICI-refractory RCC.
Future Directions: Novel Trials & Approaches.
- New ICI targets: LAG-3, TIM-3, TIGIT, OX40, 4-1BB.
- Early CAR-T trials for RCC.
- MDSC targeting to enhance immune response.
- Focus on better patient selection for ICI rechallenge.
Takeaway: ICI rechallenge shows limited benefit in RCC.
Future research should focus on novel targets & patient selection!
A huge thanks to my amazing mentors Brian Rini, Katy Beckermann and to our fantastic co-author Paulo Amaral for their precious contribution!”
Immunotherapy Strategies After Immune Checkpoint Inhibitor Exposure in Renal Cell Carcinoma.
Authors: Giulia Claire Giudice, et al.
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