Hello and I hope you’re doing well, staying safe today. I want to thank ecancer and OncoAlert for the opportunity to discuss a couple of interesting presentations during the 2020 virtual ESMO. It was a terrific meeting, very well done, and kidney cancer was actually well represented.
I want to first start by a study by the name CheckMate 9ER that was part of the Presidential, the plenary, session. This was a randomised phase III trial of the combination of cabozantinib, a tyrosine kinase inhibitor, with nivolumab, the PD-1 inhibitor, versus standard sunitinib in all risk groups. The primary endpoint was progression free survival and it was doubled actually, from 8.3 to 16.6 months. In addition, and most importantly, the study showed a response rate that is doubled with the experimental arm and the overall survival benefit was a 40% decrease in the risk of death. The toxicities were manageable and the treatment discontinuations due to adverse events were low in both groups.
Interestingly, in this trial also patient reported outcomes were presented and actually quality of life questionnaires using the FKS I-19 and FKSI-DRS favoured the combination at almost all time-points and this was statistically significant. So soon we may be having another option for metastatic renal cell cancer patients which is really very refreshing.
A couple of other presentations that caught my attention, one is actually a study with a cabozantinib also based combination but with the PD-L1 inhibitor atezolizumab from Dr Pal and Dr McGregor, the first study in clear cell RCC using a dose of 40mg or 60mg. With both the responses were over 50%, over 90% of patients had shrinkage and, again, the combination was tolerable and both the combination of atezolizumab and cabozantinib now are moving into a trial by the name CONTACT-03 which is a randomised phase III trial in the post-IO setting.
Close to that actually Dr McGregor from Dana Farber presented the same combination, cabozantinib and atezolizumab in non-clear cell RCC which is an unmet medical need, showing a response rate in the range of 30% and again tolerability. So these are also good news for patients how things are progressing.
Another abstract that caught my attention was an abstract by Dr Zengin from City of Hope, mentored by Dr Pal actually. It was the largest assessment of circulating tumour DNA in metastatic RCC, over 800 patients, and it validates previous findings that we can detect circulating tumour DNA in kidney cancer. This is a tumour that doesn’t shed a lot of DNA. Despite being rare there are some actionable genomic alterations such as MET, BRCA1/2, EGFR were found. Interesting enough they did a concordance analysis that suggested that both circulating tumour DNA and tissue based genomic profiling can be complementary because some genetic alterations were seen in the blood but not the tissue and vice versa. So this is refreshing.
Finally I want to touch base on a French trial by the name BIONIKK. This is a trial where patients were looked at initially and selected based on their biomarker status. I wanted to highlight the study because we know that these are very, very difficult to conduct studies but kudos to the authors who were able to work on a study like this. So it really paved the path towards biomarker-based prospective clinical trials.
So, again, I want to thank ecancer, I want to thank OncoAlert and all of you for listening to the updates of kidney cancer during ESMO 2020. It was a terrific meeting and thank you very much.