With the recent approval of the combinations of axitinib with the immune checkpoint inhibitor (ICI) pembrolizumab or avelumab for first-line treatment of advanced renal cell carcinoma, guidance on how to distinguish between immune-related adverse events (AEs) caused by ICI versus axitinib-related AEs is necessary to optimise therapy with axitinib-ICI combinations.
The recommendations here are based on (1) systematic review of published evidence, (2) discussion among experts in the field and (3) a survey to obtain expert consensus on specific measures for therapy management with the combinations axitinib/avelumab and axitinib/pembrolizumab. The experts identified areas of AEs requiring unique management during treatment with axitinib-ICI combinations that were not covered by current recommendations. Diarrhoea, hepatic toxicity, fatigue and cardiovascular AEs were found to be applicable to such specialised management. Triage between immune-suppressive and supportive measures is a key component in therapy management. Clinical monitoring and experience with both classes of agents are necessary to manage this novel therapeutic approach. We focused on AEs with an overlap between axitinib and ICI therapy. Our recommendations address AE management of axitinib-ICI combinations with the aim to improve the safety of these therapies.
British journal of cancer. 2020 Jun 26 [Epub ahead of print]
Viktor Grünwald, Martin H Voss, Brian I Rini, Thomas Powles, Laurence Albiges, Rachel H Giles, Eric Jonasch
Interdisciplinary GU Oncology, West German Cancer Center Essen, Clinic for Urology and Clinic for Medical Oncology, University Hospital Essen, Essen, Germany. ., Memorial Sloan Kettering Cancer Center, New York, NY, USA., Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA., Barts Cancer Institute, Queen Mary University of London, London, UK., Gustave Roussy Institute, Université Paris Saclay, Villejuif, France., International Kidney Cancer Coalition, Duivendrecht, The Netherlands., The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/32587360