Advanced Renal Cell Carcinoma: Tailoring Second-Line Therapy After Prior Immunotherapy

Dr. Monty Pal discusses his approach to selecting second-line therapy for advanced renal cell carcinoma (RCC) based on the type of first-line immunotherapy regimen previously received. He explains that prior treatment exposure, patient fitness, and the need for rapid disease control are key factors influencing subsequent treatment decisions. Following progression on dual immunotherapy, Dr. Pal describes the continued role of cabozantinib-based therapy for most patients, while noting that alternative tyrosine kinase inhibitors may be appropriate for individuals with significant frailty or concerns regarding treatment tolerability. He also reviews the clinical considerations for using belzutifan, emphasizing that he generally reserves it for carefully selected patients who are unable to tolerate tyrosine kinase inhibitors or who do not require an immediate therapeutic response. The discussion highlights the importance of individualizing sequencing strategies in advanced renal cell carcinoma by balancing efficacy, toxicity, disease characteristics, and patient-specific treatment goals.