Renal Cell Carcinoma

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An expert discusses how medical professionals counsel patients on adverse event (AE) risks with tyrosine kinase inhibitors (TKIs) such as lenvatinib/everolimus by highlighting key safety distinctions, including hypertension (HTN), fatigue, and diarrhea. For third-line tivozanib, tolerability and common toxicities (eg, Palmar-Plantar Erythrodysesthesia (PPE), HTN) are considered. AE incidence, discontinuation rates, and drug interactions guide treatment choices. Managing toxicities involves prevention, monitoring, and mitigation strategies, with dose modifications tailored based on severity and combination regimens. Community oncologists are advised on proactive AE management to optimize outcomes.

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An expert discusses using sequence therapies based on disease progression, patient factors, and resistance mechanisms. After a first-line tyrosine kinase inhibitor plus immune checkpoint inhibitor (TKI +  ICI) regimen, preferred subsequent-line options include alternative TKIs, chemotherapy, or combination strategies, tailored to patient response and tolerability.

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An expert discusses how third line (3L) systemic therapy for metastatic renal cell carcinoma (mRCC) is guided by prior treatments, patient comorbidities, and drug-specific profiles. Options include tyrosine kinase inhibitors (TKIs; eg, tivozanib, cabozantinib), mTOR inhibitors (eg, everolimus), and immune-oncology– based approaches. Efficacy, tolerability (grade 3/4 adverse events [AEs]), and pharmacokinetic (PK) differences drive selection. Dose modifications, such as for tivozanib and lenvatinib/everolimus, balance efficacy and safety. Selection prioritizes sequencing strategy, with evidence (eg, Pal 2022) supporting reduced-dose efficacy.