DR MOTZER: There are limitations with the current drugs. There’s lack of complete remissions. Responses are not usually durable. They’re usually for a time period. And there’s toxicity issues.
There are some newer TKIs that are in development that look at VEGF receptor plus other pathways that we think are important, including dovitinib, or XL-184, which looks at FGF and C-MET. So there are some newer TKIs that are being looked at.
With regard to novel agents, I think the group of agents that I find most exciting are the checkpoint inhibitors that are being developed. And I think it may be possible to develop those alone or as a biomarker or even in combination with some of the VEGF-targeted therapies.
DR LOVE: Tom?
DR HUTSON: Renal cell has been unprecedented, with rapid development of 7 new drugs in approval within a very short time period. And to be honest, that development has outpaced, I think, in my mind, the optimal use of these drugs — we don’t know how to optimally use them. So I implore that we, as an RCC community, continue to investigate strategies that will allow us to understand the current drugs and utilize them better.
For instance, we mentioned alternative dosing schedules. So I would ask that we try to do trials there to explore these. So I think although we may be at a plateau on our current group of VEGF inhibitors, we certainly have lots to do to understand how to utilize them optimally.
DR LOVE: Final comment, David?
DR McDERMOTT: So I think we’ve seen big changes in the outcomes of our patients over the last 10 years, probably doubling of overall survival for the typical patient, which is exciting. I think we need to continue to look for big differences in our clinical trials to get these agents approved, just from practical standpoints, but also that’s what our patients are looking for, is how do we make the next big leap? The immunotherapy/VEGF story may be interesting. Certainly, when you look at the bevacizumab/interferon combination trial, those 2 drugs together seemed to get more than just an additive benefit. So maybe there’s something to immunotherapy plus a VEGF inhibition strategy.