Bristol and Exelixis score in kidney cancer, but will it be enough?

Another unequivocally positive study of a PD-1-VEGF combination in kidney cancer presents oncologists with a problem they probably consider themselves fortunate to have: which regimen to choose? Following Keytruda plus Inlyta and Bavencio plus Inlyta, Bristol-Myers Squibb and Exelixis today unveiled topline data from Checkmate-9ER, a trial of Opdivo and Cabometyx; impressive hazard ratios were detailed for progression-free and overall survival. Of course, the real competition here is Keytruda, which in Keynote-426 blew previous studies out the water; until a full readout of Checkmate-9ER is available it is hard to know how effectively Bristol and Exelixis might compete. A cross-trial comparison, with the usual caveats, suggests that the game is still on. Keynote-426 generated very impressive responses at interim readout, though later cuts of the data showed a very similar reduction in the risk of death to the 9ER result. On progression-free survival it is the Opdivo combination that appears to have an edge, although again the numbers behind this result need to be known. Still, the Keytruda/Inlyta combo has been available in this setting since April 2019, and first to market might well be the most important factor for commercial success.