Dr. Rini on Managing the Toxicity of Pembrolizumab Plus Axitinib in mRCC

[D.ap]

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https://www.onclive.com/onclive-tv/dr-r ... ib-in-mrcc

[Olga]

Higher combination regimens toxicity versus monotherapy was one of the reason we choose to go with Keytruda only versus K+A, off label. The number of the patients that had to discontinue the treatments due to toxicity is more than double in combination trials versus a monotherapy, so we wanted to make sure Ivan is able to stay on K long enough to get a benefit from it.

[D.ap]

Yes I so agree
Injurious situations , being chemo induced , and or surface induced, can perpetuate a patients metastatic progression ?
What is your thoughts .

[D.ap]

viewtopic.php?f=3&t=1846#p14534

[Olga]

With any injuries/trauma/side effects there is an inflammation or the growth factors elevation that can cause the growth in metastases, so the ricks and benefits have to be carefully evaluated. But in Ivan's case we were afraid that in case of the combination treatment he would need to drop out of the treatment due to excess toxicity before there is an immune response.

[D.ap]

I agree with your thoughts as toxicity can be a inducer to inflammation , then consequently to metastatic growth .

https://www.ncbi.nlm.nih.gov/pmc/articl ... 38128title

Why risk it .

Thanks for the input .

[Olga]

The risk for the combination treatment is usually justified by the better response rate. I.e. more toxicity/risk of dropping off the treatment versus better response. If there are the numbers supporting each scenario, then it is easier to evaluate. But in case of ASPS, in some regiments the single drug regiments were not evaluated so there is no data available to assume the better expected response numbers in case of the combination regimens, with the increased toxicity.