Patients with advanced kidney cancer have a new option in a combination therapy that will afford them a longer and better life. Kidney cancer can be hard to cure, but new targeted therapies and immunotherapy bring renewed hope.

According to a recent article in Cure Today, results from the CheckMate 9ER trial show that the combination of Opdivo and Cabometyx may prolong overall survival with minimal side effects and improve the patient’s quality of life.

Improvements were also recorded in the time patients survived without disease progression (progression-free survival or PFS) as compared to Sutent, the current standard of care.

Previous advances had improved PFS but had not impacted overall survival for late-stage kidney cancer. Professor David Cella of Northwestern University’s Feinberg Medical School commented on the importance of the CheckMate trial. He referred to immunotherapy’s impact on improving survival time for kidney disease and similar disorders. Professor Cella believes trial results show evidence of improved overall survival.

About CheckMate 9ER

The researchers focused on reports by enrolled patients on their health, symptoms, and general well-being.

Advanced renal cell carcinoma patients (n-323) were treated with Opdivo and Cabometyx. The second cohort of 328 patients received Sutent. All were previously untreated.

Assessments were made of the patient’s quality of life and symptoms related to the disease at the onset of the trial. Patients’ health status was then monitored for an average of twenty-three months.

At the trial onset, both patient groups reported minimal symptoms, yet the combination of Opdivo and Cabometyx exceeded Sutent in outcomes and exhibited overall lower risk.

Dr. Cella explained that generally combining two drugs might extend the survival period but negatively affect the patient’s quality of life.

He enumerated the possible causes as:

• The combination is being judged against a placebo
• The combination results in additional toxicity
• The combination may be effective against cancer but destructive to healthy body tissues

This adds up to improved survival but decreased quality of life.

Yet Dr. Cella adds that if a patient is asked whether the risk is worth it, most patients respond that it is.

The federal government has entered the arena to promote patient involvement through its new patient-centered institute associated with the Affordable Care Act.

The FDA has joined the move to patient-centric care with their Cures Act encouraging the patient’s perspective during clinical trials.

Dr. Cella advises patients to present standard questions such as should they expect a partial or complete response.

But in addition to the usual questions the patient should ask:

• What symptoms should I expect?
• Will I experience fatigue?
• What is the pain level accompanying this treatment?
• Should I expect mouth sores, vomiting, and nausea?

It is recommended that these questions be asked prior to making a final decision.

About a second opinion:

Dr. Cella encourages patients to ask about the stage of their cancer, the risks involved, and the treatment options. But most importantly he advises not to hesitate to ask for a second opinion.

In conclusion, Dr. Cella suggests speaking to the team about changing course if the treatment does not appear to be moving along as anticipated.