Drug combination boosts kidney cancer survival in trials

Combining a targeted cancer drug with an immunotherapy extends the lives of some patients with advanced kidney cancer, according to two clinical trials.

Patients receiving the two drugs lived longer on average than those receiving a single targeted drug.

The results, published in the New England Journal of Medicine, suggest that the combination treatment could become a new standard treatment for patients whose kidney cancer has spread to other parts of the body.

These patients currently receive a single targeted drug on the NHS in the UK.

Dr Lisa Pickering, a kidney cancer expert at St George’s Hospital and The Royal Marsden in London, said the results are likely to change the way that patients with advanced kidney cancer are treated around the world.

“Together they’re the first randomised trials to demonstrate that the combination of a targeted treatment and an immunotherapy is better than a targeted treatment alone,” she said.

Boosting survival

Both trials looked at combinations of an immunotherapy treatment, which boosts the immune system’s ability to to kill cancer cells, and a targeted therapy.

One trial compared a combination of the immunotherapy drug avelumab (Bavencio) and targeted agent axitinib (Inlyta) with standard treatment, sunitinib (Sutent), in 886 patients.

Patients taking the drug combo lived for an average of 13.8 months without their cancer getting worse, compared with 7.2 months for those taking sunitinib.

In the second trial, patients who took a combination of the immunotherapy drug pembrolizumab (Keytruda) with axitinib lived for 15.1 months on average without their cancer getting worse, compared with 11.1 months for those taking sunitinib.

9 in 10 patients (89.9%) taking the combination therapy were still alive after 12 months, compared with 8 in 10 (78.3%) of those who took sunitinib.

In both trials, the side effects of the combination treatment were similar to those seen in studies where patients took the  immunotherapy or targeted drug alone.

This includes diarrhoea and high blood pressure for targeted therapies, and diarrhoea and flu-like symptoms for those taking immunotherapy.

Group benefits

Doctors can classify kidney cancers based on how well patients might do on treatment (prognosis). There are three groups that range from those who have the best prognosis, called the favourable risk group, to those who have the worst prognosis.

Both trials included patients in all three groups. The trial testing pembrolizumab included more patients with a favourable prognosis.

Pickering said that these combinations are the only ones so far that have been shown to be more effective than sunitnib in patients in all three groups.

Trials of other drug cocktails, including a combination of two immunotherapies, were only found to be effective in patients with moderate to poor prognosis.

The combination of two immunotherapy drugs was rejected for routine NHS use in England by the National Institute for Health and Care Excellence (NICE) in December 2018.  

‘Disappointing’

Pickering said the latest trial results put a spotlight on the current situation in the UK, where a combination of immunotherapy treatments is not currently approved for NHS use by NICE. 

NICE said it rejected the combination of ipilimumab (Yervoy) and nivolumab (Opdivo) because it was too expensive and there wasn’t enough long-term data on how patients were doing after treatment.

Speaking at the time, Rose Gray, Cancer Research UK’s policy manager, called the decision disappointing for patients across the UK living with this specific type of cancer.