Therapeutic Approach for Metastatic Renal Cell Carcinoma - Episode 2
Neeraj Agarwal, MD:So, what factors did I keep in mind when I was making a treatment decision for this patient? I think the first one was the IMDC risk factorhow many risk factors she had. She had 2 risk factors: presence of onset of metastatic disease within 1 year of surgery—within 1 year of diagnosis of localized kidney cancer—and high calcium. However, I also looked at her performance status. She was doing really well. She did not have really a lot of symptoms. She wanted to have an independent lifestyle. She did not want to visit me in the hospital multiple times. And, very importantly for me, the tumor did not express PD-L. So, upon PD-L1 testing, the tumor expression of PD-L1 was less than 1%, so those were the factors that I kept in mind while making a clinical decision for cabozantinib in this case.
For this patient with a newly diagnosed metastatic renal cell carcinoma, how do I pick which 1 to choose from? I have sunitinib, pazopanib, and cabozantinib. And very soon, nivolumab with ipilimumab will be approved.
Transcript edited for clarity.
Case Scenario: A 73-year old female with rapidly progressing mRCC