Dr. Bupathi on Considerations for Second-Line Sequencing in RCC

Manojkumar Bupathi, MD, MS, medical oncologist, Rocky Mountain Cancer Centers, discusses considerations for second-line treatment sequencing in clear cell renal cell carcinoma (RCC).

A main consideration in sequencing therapy for patients with RCC is knowing what prior treatment the patient received in the first-line setting, as this informs how they should be treated in the second-line setting, Bupathi says. For example, if a patient received pembrolizumab (Keytruda) plus lenvatinib (Lenvima) in the first-line setting, they should not receive lenvatinib in the second-line setting. Likewise, if a patient received cabozantinib (Cabometyx) plus nivolumab (Opdivo) in the first-line setting, they should not receive cabozantinib in the second-line setting and require an alternative regimen, Bupathi explains.

Sequencing is becoming more challenging because clinicians do not have all of the necessary data to make informed decisions and several second-line drugs have been moved into the frontline setting, Bupathi concludes.