Sick in the head.

Nivolumab is a category 1 option for progressive metastatic renal cell carcinoma (RCC). It’s also category 1 in combo with ipilimumab in the front-line setting for poor-intermediate risk RCC. The GETUG-AFU 26 NIVOREN trial was a phase 2 trial of nivo for clear cell RCC that progressed on VEGF-targeted therapy. This spin-off takes a look at patients who had visible, asymptomatic brain mets while enrolled to assess the intracranial activity of single agent nivo. Of note, nearly 40% of patients had multiple visible mets. Just 12% of the patients with previously untreated brain mets had an intracranial response, and over 70% eventually required focal brain radiation. In addition, zero patients with multiple brain mets or mets > 1 cm saw a response. TBL: Don’t turn off the LINAC for patients with RCC brain mets on nivolumab because intracranial activity is low. | Flippot, J Clin Oncol 2019