Experts Discuss the RCC Landscape and Available Therapy for Patients

Factors Influencing Frontline Therapy Options for Favorable-Risk RCC

Naomi B. Haas, MD, discusses the choice of frontline treatment for favorable-risk patients with advanced clear cell renal cell carcinoma.

Naomi B. Haas, MD, director of the kidney and prostate cancer program at Penn Medicine and professor of medicine at the Hospital of the University of Pennsylvania, discusses the choice of frontline treatment for favorable-risk patients with advanced clear cell renal cell carcinoma (RCC).

According to Haas, the 3 approved frontline tyrosine kinase inhibitor/immune checkpoint inhibitor combinations were superior to sunitinib (Sutent) in favorable-risk patients but none of the 3 stood out as the best option in terms of patient outcomes. The choice of regimen can come down to other factors such as the different adverse event (AE) profiles and the patients’ ability to tolerate therapy. Additionally, she says she might use cabozantinib (Cabometyx) plus nivolumab (Opdivo) in a patient with bone metastases since it has activity against the MET pathway, which tends to have better outcomes for bone metastases.

Cabozantinib plus nivolumab or lenvatinib (Lenvima) plus pembrolizumab (Keytruda) could also be more appropriate than axitinib (Inlyta) plus pembrolizumab in patients who have high disease burden since these regimens were shown in trials to be better at providing rapid and deep responses.


0:08 | The cabozantinib/nivolumab, the axitinib/pembrolizumab and the lenvatinib/pembrolizumab patients all did well with favorable-risk disease but compared [with] a single-agent tyrosine kinase inhibitors such as sunitinib, which was the comparator arm, there wasn't a huge difference in how they did. Some of it is tailored to [AEs]. For example, if a patient develops bony metastases, and they're in the favorable-risk category, I might use cabozantinib/nivolumab a little bit more often than lenvatinib/pembrolizumab or axitinib/pembrolizumab, just based on the MET activity that is seen in cabozantinib, and how MET mutations may work a little bit better in patients with bone metastases, or MET-directed therapy, I should say.

1:16 | If they have a very high burden of disease, and I need shrinkage and I need shrinkage quickly, I would use either nivolumab and cabozantinib or I would use lenvatinib with pembrolizumab because those 2 [regimens] had a pretty decent depth of response and did well in those categories.