Dr. Pal on Sequencing Challenges for the Treatment of Patients With RCC

Sumanta Kumar Pal, MD, medical oncologist, assistant clinical professor, Department of Medical Oncology and Therapeutics Research, City of Hope, discusses the challenges with sequencing the therapies available for patients with renal cell carcinoma (RCC). Pal shared this insight in an interview during the 2016 OncLive State of the Science Summit on GU Cancer.

Currently, there are a plethora of agents available for the treatment of patients with RCC: immunotherapies, VEGF-targeted therapies, and MTOR-targeted agents. Regarding immunotherapy, nivolumab (Opdivo) and interleukin-2 is approved. In the VEGF group, cabozantinib (Cabometyx) is the newest FDA-approved agent, joining sunitinib (Sutent), sorafenib (Nexavar), pazopanib (Votrient), axitinib (Inlyta), and bevacizumab (Avastin). Another 2016 FDA approval includes the combination of lenvatinib (Lenvima) and everolimus (Afinitor). Moreover, another available mTOR medicine is temsirolimus (Torisel).

While there are many agents available for patients, Pal explains that it is challenging to optimize sequencing of therapy. For the time-being, oncologists are comparing data from phase III clinical trials to guide treatment decisions. Additionally, "sandwiching in" clinical trials early and offering new pathways and new treatments that exploit those pathways is an appropriate way to optimize outcomes overall.