RENAL CANCER In a retrospective analysis, rechallenge with immunotherapy delivered ORR 23% (compared with 37% ORR for first exposure); responses at rechallenge were not restricted to those who had responded at first exposure.

Evaluation of the Safety and Efficacy of Immunotherapy Rechallenge in Patients With Renal Cell Carcinoma

IMPORTANCE

Several immune checkpoint inhibitors (ICIs) are approved for use in patients with metastatic renal cell carcinoma (mRCC), but the efficacy and safety of ICI rechallenge in mRCC is unknown.

OBJECTIVE

To evaluate the safety and efficacy of ICI rechallenge in patients with mRCC.

DESIGN, SETTING, AND PARTICIPANTS

This multicenter, retrospective cohort study included consecutive patients with mRCC from 9 institutions in the US who received at least 2 separate lines of ICI (ICI-1, ICI-2) between January 2012 and December 2019.

EXPOSURE

Receipt of an ICI (anticytotoxic T-lymphocyte-associated protein 4, anti–programmed cell death protein 1, or anti–programmed cell death ligand 1), alone or in combination with other therapies, in at least 2 separate lines of therapy for mRCC.

MAIN OUTCOMES AND MEASURES

Investigator-assessed best overall response and immune-related adverse events.

RESULTS

A total of 69 patients were included. Median (range) age at diagnosis of mRCC was 61 (36-86) years. Of these, 50 were men and 19 were women. The most common therapies received at ICI-1 were single-agent ICI (n = 27 [39%]) or ICI in combination with targeted therapy (n = 29 [42%]), while at ICI-2, the most common therapies were single-agent ICI (n = 26 [38%]) or dual ICI (n = 22 [32%]). Most patients discontinued ICI-1 owing to disease progression (n = 50 [72%]) or toxic effects (n = 16 [23%]). The overall response rates at ICI-1 and ICI-2 were 37% and 23%, respectively. The likelihood of a response at ICI-2 was greatest among patients who had previously responded to ICI-1 (7 of 24 [29%]), although responses at ICI-2 were seen in those who had progressive disease as their best response following ICI-1 (3 of 14 [21%]) as well as in those who received single-agent ICI at ICI-2 (7 of 23 [30%]). Grade 3 or higher immune-related adverse events were seen in 18 patients (26%) and 11 patients (16%) at ICI-1 and ICI-2, respectively. There were no treatment-related deaths.

CONCLUSIONS AND RELEVANCE

The findings of this multicenter cohort study suggest that ICI rechallenge in patients with mRCC may be safe and reasonably efficacious, with an overall response rate of 23%. Data from prospective studies are needed to validate these findings and determine the role of sequential ICI regimens in treatment of mRCC.

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Scientific Application Note

Biliary Tract Cancer Evaluation of Combination Nivolumab and Ipilimumab Immunotherapy in Patients With Advanced Biliary Tract Cancers. Subgroup Analysis of a Phase 2 Nonrandomized Clinical Trial

Oliver Klein, MD1,2; Damien Kee, MD1,3; Adnan Nagrial, MD4; etalBen Markman, MD5,6; Craig Underhill, MD7; Michael Michael, MD3; Louise Jackett, MD8; Caroline Lum, MD5; Andreas Behren, PhD2,9; Jodie Palmer, PhD2,9; Niall C. Tebbutt, MD1,10; Matteo S. Carlino, PhD4; Jonathan Cebon, PhD1,2,9 Author Affiliations JAMA Oncol. Published online July 30, 2020. doi:10.1001/jamaoncol.2020.2814 Key Points Question:  Is combination immunotherapy with nivolumab and ipilimumab associated with positive outcomes in patients with advanced biliary tract cancers?...

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