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Studies show that immunotherapies can alter the treatment of kidney cancer



"This is a testament to the principle that we can do this if the medications are in the same class and tolerated in combination," Dr. Toni Choueiri, Director of the Lank Center for Genitourinary Oncology at the Dana-Farber Cancer Institute. Brigham and Women's Hospital and Professor of Medicine at Harvard Medical School, Boston, was the lead author of the Avelumab study. He was involved in previous pembrolizumab research but not in the new pembrolizumab study.

New immunotherapies as a whole "have revolutionized many tumors," he said.

Immunotherapy is a treatment approach that uses specific parts of the body's own immune system to attack and attack a disease like cancer. This approach can be in many forms ̵
1; vaccines, antibody or cell therapies or medications – and can be administered by injections, pills or capsules, topical ointments or creams, or a catheter.

Immunotherapy may also be combined with a different form of therapy than therapy, as shown in the two new studies.

Avelumab-axitinib study involved 886 patients with renal cell cancer. Of these, 442 received avelumab plus axitinib as treatment and 444 received the chemotherapy drug sunitinib or Sutent, a first-line treatment for advanced renal cell carcinoma.

The study showed that progression-free survival averaged 13.8 additional months of life in patients treated with avelumab plus axitinib compared to 7.2 months in sunitinib-treated patients.

The pembrolizumab-axitinib study involved 861 patients with renal cell cancer. Of these, 434 received pembrolizumab intravenously plus axitinib as a treatment and 429 sunitinib.

The study showed that progression-free survival was 15.1 months in the pembrolizumab-axitinib group and 11.1 months in the sunitinib group. Patients receiving the combination therapy had a 47% lower risk of death and a 31% lower risk of progression or death than patients receiving sunitinib.

The percentage of patients still alive 12 months after treatment was 89.9% of the pembrolizumab axitinib group compared to 78.3% in the sunitinib group.

These study results "will change the standard of care for this disease in absolute terms, and what has been seen is truly an unprecedented overall survival benefit at the lowest hazard ratio, which is the greatest benefit ever seen in kidney cancer," said Dr. Brian Rini, Cleveland Clinic Oncologist and Professor of Medicine, Case Western Reserve University, Cleveland. He was the first author of the pembrolizumab study.

"We measure the effectiveness of anticancer drugs in many different ways – patients who live longer in the first instance – but also other measures, and in all of these measures, this combination was superior to sunitinib," he said. These other measures include response to the treatment and progression of the disease.

In both studies, the limitations and side effects of combination therapy were what one would expect if either immunotherapy or targeted therapy were given individually. Side effects of immunotherapy may be flu-like symptoms, diarrhea or the risk of infection. Side effects of targeted cancer therapies may include diarrhea, hypertension, thyroid problems or liver problems such as hepatitis and increased liver enzymes.
"These are not easy treatments that can be tolerated," Dr. J. Leonard Lichtenfeld, interim chief physician of the American Cancer Society, who was not involved in either study.

"We have learned from other studies, not from kidney cancer, but from other studies, as we begin to combine some of these treatments. The effects can be considerable, and that in itself can be a problem, but the fact is that the addition of the immunotherapeutic prolonged survival longer than standard therapy. "

" Just a matter of a few months, and is this really an improvement given the cost and side effects of immunotherapeutics? But it is also very likely that we have these patients did not pursue it long enough, "he said. "It may therefore happen that some patients will experience a remarkable improvement as a result of this treatment."

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The combination treatments studied in both studies are not yet approved by the US Food and Drug Administration for Renal Cell Carcinoma, and the cost of the treatments is unknown. [19659007] Nevertheless, the question remains: "Does this change the standard of care? Well, I think, whether this changes the standard of care or not, is discussed among experts," said Lichtenfeld.

"I do not think this study will make an immediate difference overnight, but I suspect that over time it will become a standard treatment for metastatic or recurrent renal cell carcinoma – kidney cancer."

Dr. Bernard Escudier, former chairman of the Genitourinary Group of the Gustave Roussy Institute in Villejuif, France, wrote an editorial accompanying the two studies in the New England Journal of Medicine.
He noted that sunitinib was the standard for kidney cell cancer treatment in 2007. Last year, the combination of two immunotherapies – nivolumab or opdivo and ipilimumab or yervoy – showed better efficacy than sunitinib and became the new standard.

Well, it is noteworthy that this is the case Both of these studies had positive results and demonstrated superiority over sunitinib in terms of progression-free survival and the objective response rate. The pembrolizumab study also showed a benefit in terms of overall survival, "wrote Escudier," and both combinations are expected to become new standards of care and to be included in future guidelines. "

Consider experts in the field not only the new studies, but also the question of how immunotherapies in general influence the treatment approaches 19659025]
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