Bladder Cancer Update & Renal Cell Cancer Update, 2017 (Video Program)Integration of lenvatinib/everolimus into the clinical algorithm for patients with RCC
3:00 minutes.
TRANSCRIPTION:
DR MOTZER: Lenvatinib is a VEGF-targeted therapy that also targets FGF, which is felt to be in a pathway, fibroblast growth factor receptor, which is felt to be an important pathway for resistance as well. And for that drug, there was preclinical evidence that it worked very closely, very well, with everolimus in the preclinical model. So in that trial, we initially did a study, which was a lead-in of the combination, and found a dose that seemed to be well tolerated for patients, with a lower dose of lenvatinib and a lower dose of everolimus. And then we moved into a randomized Phase II trial comparing lenvatinib/everolimus versus lenvatinib versus everolimus alone. It wasn’t originally designed to be a registration trial, but it was a well-conducted study. There were scans that were collected after the study was over and reviewed by an independent response committee. And it showed a very powerful effect for the combination, with the median progression-free survival of over 14 months, which is the longest that we’ve seen in this sort of setting. So it was approved based on a Phase II trial with that long PFS confirmed by independent review and also a strong trend in overall survival at the initial assessment, which became statistically significant over time. DR LOVE: So what about in your own practice outside a trial setting? Are you using this combination? DR MOTZER: Yes, I am. For patients who progress on checkpoint inhibitors, I offer them either cabozantinib or lenvatinib/everolimus. And I’m doing that because of this new data with the survival benefit and also to gain more experience, personal experience, with those compounds. And I’m finding it, in my own hands, to be relatively well tolerated, including the lenvatinib/everolimus, and particularly effective. So I think that they are good medications for our patients. DR LOVE: When, right now in your practice, are you utilizing everolimus monotherapy in any situations? DR MOTZER: I think that everolimus monotherapy is bumped back. I think it still may have a role in refractory patients, patients who have been through a number of the VEGF-targeted therapies. So I think that we still use it, but it’s bumped back in the line, similar to what happened with sorafenib. We still use sorafenib as well, but it’s more in the refractory patient. |