RCC Treatment Selection Should Incorporate Patient Discussion and Goals

Manojkumar Bupathi, MD, MS, genitourinary medical oncologist at Rocky Mountain Cancer Centers and executive co-chair for genitourinary research for Sarah Cannon Research Institute in Denver, Colorado, discusses physician perspectives on treatment selection for frontline metastatic renal cell carcinoma (RCC) from a Case-Based Roundtable event.

Bupathi highlights the reasons given for using different therapies. Participants discussed choosing dual immunotherapy (IO) with nivolumab (Opdivo) plus ipilimumab (Yervoy) or IO plus tyrosine kinase inhibitor (TKI), as well as why they would select the TKIs cabozantinib (Cabometyx), axitinib (Inlyta), or lenvatinib (Lenvima) to use with IO, based on long-term efficacy data from trials and different adverse event (AE) profiles. He also said that in some cases it still may be beneficial to use a single-agent TKI in the first line instead of a combination.

In general, Bupathi concluded that multiple good options are available and could be used depending on what the physician’s and patient’s goals are, making it crucial to have a discussion with the patient that covers the pros and cons of different regimens. Additionally, physicians should become familiar with the different AE profiles of each combination regimen.

TRANSCRIPTION

0:10 | It was important discussion from the case-based practice to understand the perspectives of community oncologists on how they choose their first-line therapy now that we have extended follow-up for all these regimens. It was interesting to see the differences between IO plus IO vs IO plus TKI, and the reasons why some choose one over the other, as well as the various options in terms of TKI partner when using in combination with IO. It was also interesting to understand that there are some times where it may be beneficial to use a single-agent TKI as well, as opposed to the standard of care, or normally thought, doublet therapy. So I thought this was an important perspective to gain.

1:03 | One of the key takeaways is that we have good options. We cannot really say that one option is substantially better than another option. I think there's a role for every single option that is out there. It depends on what your goals are. It's important to have a discussion with the patient, weighing the pros and cons of all the options that are existing. I think it's important from a physician standpoint, to understand how you manage the [AEs] for any one of these combination therapies that are out there.