Dr. Agarwal on Patient Selection in Frontline Advanced RCC

Neeraj Agarwal, MD, associate professor, Division of Oncology, Department of Medicine, University of Utah School of Medicine; and director, Genitourinary Oncology Program, Oncology Division, co-leader, Urologic Oncology Multidisciplinary Program, associate director of Clinical Trials, Huntsman Cancer Institute, discusses patient selection in the frontline treatment of patients with advanced renal cell carcinoma (RCC).

It can be challenging to select the optimal frontline regimen now that there are 3 from which to choose, explains Agarwal. Each regimen has been compared with single-agent sunitinib (Sutent) in clinical trials. However, the regimens have never been compared head-to-head against each other. In general, if patients have rapidly progressive, high-volume disease and there is concern about primary progressive disease as the best response, patients typically don't get to see the subsequent lines of therapy, says Agarwal. If the concern is disease control, then the focus is placed on responses and progression-free survival benefit, and a targeted therapy alone, or a combination like pembrolizumab (Keytruda) plus axitinib (Inlyta) may be beneficial.

On the other hand, if a patient has more indolent disease where immediate disease control is not the primary concern, the combination of ipilimumab (Yervoy) plus nivolumab (Opdivo) may be the best choice, explains Agarwal.