Highlights

85% of patients with metastatic kidney cancer are clear cell, the rest – about 15% – are non-clear cell. The vast majority of those are papillary. There is very limited data in non-clear cell histology, other than for the most part small Phase IIs. So, by extrapolation, almost all the therapies that we use in clear cell are generally prescribed in non-clear cell as well… if I happen to have an open non-clear cell trial, which I do from time to time, that would be my preference. Alternatively, I started two patients in the last six weeks that had papillary metastatic kidney cancer on ipilimumab + nivolumab, so, we managed them the same way as clear cell. The data is basically far less compelling, but there is at least a reasonable rationale to do so.

In the last 18, maybe 24 months, I have not started a new patient on sunitinib. Basically today, we don’t really [prescribe Sutent anymore]. Assuming I have therapies that I have available to me, there isn’t a patient that I would start on sunitinib in the frontline setting… Single-agent tyrosine kinase inhibitors really are hard to justify in the frontline setting given the fact you have survival benefit from two frontline immuno-oncology trials.

Cabozantinib + atezolizumab is an interesting combination because they’ve got a very large clinical trial program going in a lot of tumors, and obviously they’ve shown some data in prostate cancer that’s intriguing. It doesn’t appear that atezolizumab when you add it to cabozantinib adds much in the way of toxicity… Also, if cabozantinib/atezolizumab shows anti-tumor activity in patients who progressed on a frontline immuno-oncology agent, it’s going to be an important consideration. Now, we don’t really have that data yet so it’s a little premature, but if you show activity in patients who’ve received immunooncology-based therapy and you’re the first one to do it, it’s going to be very important. So, if CONTACT03 is the first group that shows immuno-oncology-based response after immunotherapy progression, that’s going to be a very important benchmark.