Dr Xu on Treatment Decision-Making in RCC

Wenxin (Vincent) Xu, MD, physician, Dana-Farber Cancer Institute, assistant professor, medicine, Harvard Medical School, discusses treatment decision-making for patients with renal cell carcinoma (RCC), highlighting how he approaches treatment upon disease progression for patients in this population.

At present, treatment decisions for this patient population remain highly individualized, tailored to the specific characteristics of each individual who presents with RCC, Xu begins. There isn't a universal treatment approach that fits every individual patient, he explains, adding that several viable options are available. For example, patients experiencing rapidly progressive disease symptoms who are feeling unwell due to their illness may find benefit from treatment with the combination of an immunotherapy agent and a TKI due to the swift onset of response and high response rates associated with these types of combinations, which may alleviate their symptoms promptly, Xu elucidates.

Conversely, patients with metastatic disease who are experiencing more mild symptoms and desiring a chance at long-lasting response or even treatment-free survival are suitable candidates for ipilimumab (Yervoy) plus nivolumab (Opdivo), as the use of this regimen is backed by extensive durability data, Xu states. The course of treatment progression in this patient cohort varies, with a significant factor being the toxicities encountered during initial treatment, he expands. For instance, patients enduring TKI-associated toxicities over extended periods may find relief in transitioning to belzutifan (Welireg), offering respite from TKI-related adverse effects and potentially improving their quality of life, he elucidates.

On the contrary, patients tolerating TKI toxicities well and demonstrating robustness for further treatment may benefit from aggressive second- or third-line TKI regimens such cabozantinib (Cabometyx) or lenvatinib (Lenvima) plus everolimus (Afinitor), which are known for their continued efficacy, Xu continues. Tivozanib (Fotivda), which is another present TKI option for patients within this population, could be considered for patients who are still responsive to TKI treatment, he says. The overarching objective for many patients is to sequence treatments effectively, maximizing the chances of achieving a favorable response, Xu concludes.