DR LOVE: What about lenvatinib? What’s your overall take on it?

DR GEORGE: This is a really interesting agent, because it was developed in combination as well as a single agent in comparison to everolimus. And it, like cabozantinib, demonstrated a survival benefit over everolimus but showed its greatest survival benefit in combination with everolimus. And I think this is a really interesting aspect.

For a long time, we felt that these 2 classes of drugs were incompatible because they target similar pathways. The mTOR pathway can affect angiogenesis, and VEGF receptors can signal through mTOR. So inhibition of these 2 pathways could overlap not just in efficacy but in toxicity. And we saw that in a number of Phase I and Phase II studies. And, in fact, even in this study, they weren’t able to give full doses of the 2 drugs, and yet they saw greater overall survival with the combination.

So it’s a Phase II study. I think for me, I’d like to see a larger, broader patient population, a broader experience than just academic medical centers using something like that, to really convince us that this is a tolerable combination. But it certainly is intriguing regarding that population where, again, we’re able to use some combination therapy and demonstrate some efficacy in a population, specifically a disease where we don’t have a lot of really proven therapy.

Bladder cancer

Prostate cancer

Renal cell carcinoma

Checkpoint inhibitors