Opinion|Videos|March 6, 2025
Case (cont.): Dr Pal’s Approach Toward 2L Therapy Selection
Author(s)Sumanta Kumar Pal, MD
A panelist discusses how second-line therapy selection in metastatic RCC requires careful consideration of multiple factors including prior treatment response, individual patient characteristics, specific drug properties (such as mechanism of action and pharmacokinetics), strength of clinical evidence, and practical considerations like tolerability and quality of life, while acknowledging current evidence gaps and unmet needs in the post-ICI treatment landscape.
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Episodes in this series
Video content above is prompted by the following:
- What second-line therapy are you most likely to recommend for this patient? Why?
- Please discuss how you approach individualized second-line systemic therapy selection for patients with metastatic RCC?
- Please offer perspectives on pros/cons of current options for second-line therapy.
- What do you find most challenging about disease management in the second-line setting for patients who have received a prior ICI? What are the evidence/knowledge gaps and unmet needs?
- What factors do you consider during treatment decision making (eg, use of chemotherapy-sparing regimens, ARPI selection, triplet versus doublet combination systemic therapy), for example:
- Efficacy
- Tolerability of each (eg, rate of Grade 3/4 AEs)
- Patient clinical factors/comorbidities that would influence your use of each agent
- Are your 2L and 3L choices based on drug classification or on specific drugs?
- What are the similarities and differences between approved TKIs (eg, MOA/target selectivity, PK)?
- Strength of evidence (eg, phase 3 vs 2 data)
- How important is proportion of patients who have received prior ICI to you when weighing clinical trial data in your decision making?
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