Dr Badami on Factors Informing Treatment Selection in ccRCC and Non–ccRCC

“Although we lump all of the non–clear cell renal cell carcinomas together, they're not actually all the same. Knowing the non–clear cell renal cell carcinoma subtype is important to help determine which regimen [to select].”

Ami Umesh Badami, MD, hematologist/oncologist, Loyola University Medical Center, discusses a variety of different factors that guide treatment decision-making for patients with clear cell renal cell carcinoma (ccRCC) vs non–ccRCC.

Histology plays a critical role in guiding treatment for non–ccRCC, a category that includes a variety of subtypes with differing responses to therapy, Badami begins. Unlike ccRCC, which has more established treatment protocols, non-clear cell RCC types like papillary and chromophobe cancers exhibit unique characteristics, impacting therapeutic choices, she says. Recent data from the phase 2 SUNNIFORECAST trial (NCT03075423) underscore these differences, with results indicating variability in response rates between these subtypes. Response rates can vary between treatment with immune checkpoint inhibitors such as ipilimumab (Yervoy) and nivolumab (Opdivo) vs investigator-selected standard-of-care regimens, Badami reports. This information highlights the importance of subtype-specific treatment strategies in non-ccRCC, she states.

In papillary RCC, the most common subtype of non–ccRCC, symptom management and response urgency further inform treatment selection, Badami continues. In symptomatic patients requiring a rapid response, immune-oncology and TKI combinations can offer more rapid disease control and potentially improve quality of life, she asserts. Meanwhile, the SUNNIFORECAST findings suggest an increasing role for ipilimumab and nivolumab in these cases, Badami reiterates. Overall, a detailed understanding of histology in non-ccRCC allows clinicians to tailor treatment, taking into account both patient symptoms and subtype characteristics. This approach can provide a more effective treatment course and reflects the increasingly nuanced landscape of RCC management, she concludes.