Dr. Grigg on Frontline Tyrosine Kinase Inhibitors in RCC

Claud Grigg, MD, medical oncologist, Levine Cancer Institute, discusses frontline tyrosine kinase inhibitors (TKIs) in renal cell carcinoma (RCC).

TKIs are often referred to as inhibitors of the VEGF receptor pathway, but in reality, inhibit other kinases in the cell, says Grigg. For example, sunitinib (Sutent) is a potent inhibitor of KIT and FLT3. Additionally, cabozantinib (Cabometyx) inhibits MET and AXL in addition to other kinases. It is important to consider the toxicity profiles of these agents when deciding which one to administer, adds Grigg. The CABOSUN data revealed that the toxicities for sunitinib are mainly hematologic, whereas higher rates of stomatitis and fatigue were observed in the cabozantinib arm.

Physicians also have to consider whether patients need a quick response or not. The IMDC risk criteria are often used in that regard, notes Grigg. However, physicians looking for higher response rates and longer progression-free survival should turn to cabozantinib in the first-line setting, concludes Grigg.