Medicine Matters oncology

So what we did for this ESMO 2019 is look into the JAVELIN RCC trial. That is the trial in first line of kidney cancer, where patients were randomized to a combination of axitinib plus avelumab, therefore a dual approach of checkpoint inhibitor plus VEGF inhibition versus sunitinib.

And because the field is evolving a lot in terms of should we perform or not cytoreductive nephrectomy in our patient, what we did was to look at the patient who did not have prior cytoreductive nephrectomy. So that's about 60 patients in each of the arm of the trial that didn't have surgery on the primary before they were enrolled in the trial.

And so what we were aiming at was to look at the response rate in the kidney tumor, meaning the primary tumor which had not been operated on. So what we were able to do was to report the response rate on this primary tumor.

And very interestingly, those patients who did not have prior surgery achieved a response rate on the primary tumor in the axitinib plus avelumab arm around 35%, meaning that 35% of the patients had more than 30% tumor shrinkage on their primary versus 10% in the sunitinib arm.

It's the first report of tumor shrinkage on the primary with a dual approach of VEGF TKI plus immune checkpoint. So these data are very important. The PFS was also longer in when regarding time to progression on the primary tumor in the patients treated in the axitinib plus avelumab arm compared to sunitinib arm.

So of course this work is food for thought. And it's there for us to be able to assess what we can expect of a dual approach VEGF TKI plus checkpoint inhibitor in patients who did not undergo cytoreductive nephrectomy, because the standard has evolved in this field based on the CARMENA data.

And it's very likely that, more and more, our patient with upfront metastatic disease who required systemic treatment will be treated with a combination in first line. And it was important to assess what we can expect on the primary tumor.