Nivolumab Combo for RCC Necessitates AE Monitoring, Awareness
According to Laurence Albiges, MD, PhD, treatment of RCC with cabozantinib, nivolumab, and ipilimumab can cause potentially serious toxicities that should be closely monitored.
According to an oncologist, the treatment of advanced renal cell carcinoma with cabozantinib (Cabometyx) plus nivolumab (Opdivo) and ipilimumab (Yervoy) requires close monitoring and awareness of common adverse effects (AEs).
Laurence Albiges, MD, PhD, head of the Department of Oncology at Gustave Roussy in France, spoke with Oncology Nursing News regarding key considerations for oncology nurses and advanced practice providers related to the administration of these drugs and daily upkeep.
Albiges’ research on the subject, which demonstrated that the combination of cabozantinib with nivolumab and ipilimumab sustained a progression-free survival benefit at 45 months,1 was presented at the 2025 ASCO Genitourinary Cancers Symposium.
Because this drug combination was often followed by a VEGFR tyrosine kinase inhibitor (TKI),1 Albiges emphasizes the importance of being aware of the AEs that often accompany TKIs, including gastrointestinal toxicity, skin toxicities, and immune-related AEs. Some AEs associated with the combination and subsequent treatment can necessitate interventions such as drug holidays or treatment with steroids.
Albiges recommended that patients have full blood work and have their symptoms regularly monitored by an APP or doctor to remain aware of any serious AEs that could occur.
Transcript
From a nursing perspective, to me, this trial will not change the practice, because it will not become standard of care.
And so I believe that it's important that the nurses are well trained to manage the daily toxicity of the [tyrosine kinase inhibitors], and that sometimes requires drug holiday and symptom management, such as [gastrointestinal] toxicity or hand, foot, and other skin toxicity, but also to be aware of the immune toxicity, immune-mediated toxicity, that can be a very broad spectrum of rare entities that need to trigger prompt reaction.
So patients need to have full blood work, need to be checked by either a nurse practitioner or their doctors to rule out those high-grade toxicity, immune-mediated that will require steroids and admission and so on. So really, nivolumab plus ipilumumab is a regimen that requires a good monitoring to be able to identify and manage those immune-mediated toxicities.
This transcript has been edited for clarity and conciseness.
Reference
Albiges L, Motzer RJ, Trevino S, et al. Cabozantinib (C) in combination with nivolumab (N) and ipilimumab (I) in previously untreated advanced renal cell carcinoma (aRCC): final results of COSMIC-313. J Clin Oncol. 2025;43(5):438. doi:10.1200/JCO.2025.43.5_suppl.438
