Evidence-Based Strategies for Selecting the Appropriate Frontline Therapy in Advanced RCC - Episode 10

First-Line Treatment for Advanced Clear Cell RCC: Key Takeaways

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Closing out their discussion on advanced RCC, expert hematologist/oncologists offer key takeaways from their discussion and look toward future treatment evolution in the first-line setting.


Brian Rini, MD: Just to summarize what we’ve said, I think we agree that, right now, an anti-PD1 IO [immuno-oncology] based doublet is standard of care. We’ve sort of talked about nuances of different TKIs [tyrosine kinase inhibitors], and dosing, and different strategies around it. Use of ipilimumab/nivolumab in select populations, and the need to use ipilimumab early. I think we had a lot of good discussion around empowering the patients, and really working with patients to make these more tolerable. To me there’s always a learning curve with a new regimen in the first several dozen patients, whether it’s a given TKI, or a doublet, or maybe triplets in the future. I think working with your team to really get comfortable with using certain regimens is important. We talked a little bit about quality of life, and some of the limitations. I think we, as a field, need to do a better job of measuring it, and measuring it accurately because I know it’s meaningful to patients.

I think the adjuvant space is really going to be interesting. I kind of assumed when the KEYNOTE study was positive, they’d all be positive. Clearly, I was wrong, and we need to see the details.... We also need to be cautious because we’re overtreating a lot of people. The benefit-risk in the adjuvant setting is very different than in the advanced setting. I think we all recognize that and have had those conversations with patients.

Then where are we going in the future? Triplets. We’re going to see the first data soon, and there’s other trials going on. I think it’s going to generate a lot of discussion, and a lot of debate. And that’s always good. I think we always get smarter when we do that. We haven’t really even touched on novel drugs, and I think we also didn’t touch on biomarkers. But I think we’d all agree that a lot of what we talked about could be addressed with more effective biomarkers. We’ve not done a great job, as a field, of developing those. There are a lot of efforts ongoing, and hopefully when we’re sitting here in a few years we’ll be talking about, “Based on this biomarker I would give a triplet, or I would give adjuvant therapy,” that would be a much more informed discussion.

Thanks to both of you for your time, I really appreciate it. It’s been extremely informative. Thanks to our audience for watching this Targeted Oncology presentation. We hope you also found it useful and informative. Thank you.

Transcript edited for clarity.