Neeraj Agarwal, MD:Would I use a different dose of cabozantinib in a frailer patient? I think so. If I’m seeing a 79-year-old frailer patient than the patient I just described, I think I would start with cabozantinib at 40 mg daily and maybe further decrease the dose as long as patient is responding. So, yes, I think decreasing the dose of cabozantinib is often a wise decision in patients where we think 60-mg daily dosing may cause excessive toxicities.
Would I make a different choice as far as treatment selection is concerned for a patient whose tumor is expressing PD-L at more than 1%? I think so. If I look at the data from the CheckMate-214 trial, almost 300-plus patients out of almost 1000 patients whose tumors were expressing PD-L1 at more than 1% had dramatic progression-free survival benefit compared with sunitinib. The PFS with the combination was 22 months compared with 5 months with sunitinib. So, given these data, I do not have any doubt that PD-Lexpressing tumors or patients with PD-L–expressing tumors need treatment with ipilimumab/nivolumab combinationswithout any question.
Transcript edited for clarity.
Case Scenario: A 73-year old female with rapidly progressing mRCC
March 2017
December 2017
Comparing Choices for IO/TKI Combinations in Advanced RCC
May 2nd 2024During a Case-Based Roundtable® event, Shilpa Gupta, MD, led a discussion on the combination of immunotherapy and tyrosine kinase inhibitors for patients with advanced renal cell carcinoma in the second article of a 2-part series.
Read More
Enhancing Precision in Immunotherapy: CD8 PET-Avidity in RCC
March 1st 2024In this episode of Emerging Experts, Peter Zang, MD, highlights research on baseline CD8 lymph node avidity with 89-Zr-crefmirlimab for the treatment of patients with metastatic renal cell carcinoma and response to immunotherapy.
Listen
Sustained Treatment-Free Survival in RCC Seen With Nivolumab and Ipilimumab
April 30th 2024Nivolumab monotherapy plus salvage nivolumab/ipilimumab demonstrated superior treatment-free survival rates among patients with advanced renal cell carcinoma, especially in patients with favorable risk profiles.
Read More
Beyond the First-Line: Economides on Advancing Therapies in RCC
February 1st 2024In our 4th episode of Emerging Experts, Minas P. Economides, MD, unveils the challenges and opportunities for renal cell carcinoma treatment, focusing on the lack of therapies available in the second-line setting.
Listen
Advances in Subsequent Therapies Shake Up Sequencing of ccRCC Treatment
April 25th 2024With the approval of belzutifan and other newer data for treating patients with recurrent renal cell carcinoma, the state of subsequent therapies is advancing beyond the reuse of frontline options with impacts on duration of response and quality of life.
Read More
Ornstein Advises on Starting Dose and Management of Lenvatinib in RCC
April 21st 2024During a Case-Based Roundtable® event, Moshe Ornstein, MD, MA, provided guidance on dosing and toxicity concerns in a patient treated with lenvatinib plus pembrolizumab for advanced renal cell carcinoma.
Read More