Therapeutic Approach for Metastatic Renal Cell Carcinoma - Episode 5
Neeraj Agarwal, MD:Would I use a different dose of cabozantinib in a frailer patient? I think so. If I’m seeing a 79-year-old frailer patient than the patient I just described, I think I would start with cabozantinib at 40 mg daily and maybe further decrease the dose as long as patient is responding. So, yes, I think decreasing the dose of cabozantinib is often a wise decision in patients where we think 60-mg daily dosing may cause excessive toxicities.
Would I make a different choice as far as treatment selection is concerned for a patient whose tumor is expressing PD-L at more than 1%? I think so. If I look at the data from the CheckMate-214 trial, almost 300-plus patients out of almost 1000 patients whose tumors were expressing PD-L1 at more than 1% had dramatic progression-free survival benefit compared with sunitinib. The PFS with the combination was 22 months compared with 5 months with sunitinib. So, given these data, I do not have any doubt that PD-Lexpressing tumors or patients with PD-L–expressing tumors need treatment with ipilimumab/nivolumab combinationswithout any question.
Transcript edited for clarity.
Case Scenario: A 73-year old female with rapidly progressing mRCC