Impact of Prior Immunotherapy on First-Line Choice in Advanced Renal Cell Carcinoma

In this segment on advanced renal cell carcinoma, Dr. Geynisman raises the increasingly relevant question of how prior adjuvant pembrolizumab or earlier immunotherapy exposure influences treatment selection in the metastatic setting. Dr. McGregor and Dr. Wulff discuss how prior IO exposure introduces complexity into first-line decision making, particularly as more patients relapse after receiving adjuvant therapy. The panel highlights that in many cases, clinicians may favor VEGFR TKI-based approaches or IO-TKI combinations rather than IO-IO regimens, depending on the timing of recurrence and prior response to immunotherapy. They also note that a short disease-free interval after adjuvant pembrolizumab may suggest resistance to IO, guiding clinicians toward TKI-driven strategies. The discussion emphasizes the importance of understanding prior treatment history and disease biology when selecting therapy, underscoring that sequencing decisions in advanced renal cell carcinoma are increasingly influenced by earlier lines of treatment.