Thomas Hutson, DO, PharmD:For our particular patient who went on to receive lenvatinib/everolimus after sunitinib, at the point in which she has progression, I would consider strongly the use of immunotherapy as a third-line, leaving cabozantinib as a fourth-line option for her.
In summary, this patient’s case and unique characteristics provide us a snapshot into real-world management of intermediate-/poor-risk RCC. We see a patient who has multiple sites of disease, who gets started on traditional frontline therapy with sunitinib, has standard or less than standard response, and then moves on to second-line therapy with the combination of lenvatinib and everolimus.
I’ve discussed with you that alternative options, including nivolumab and cabozantinib, would also be considered, and in this particular patient would be employed in the third- and fourth-line setting.
Please understand that treatment options are changing rapidly in RCC. We need these options and we anxiously await the results of ongoing phase III trials. Our goal at the end of the day is to provide our patients with a longer survival, the greatest tolerability, and best quality of life.
Transcript edited for clarity.
A 70-Year-Old African-American Woman with Metastatic RCC