Role of TKI Monotherapy in Favorable-Risk Advanced Renal Cell Carcinoma

In this segment on advanced renal cell carcinoma, Dr. McGregor explores the role of VEGFR TKI monotherapy in patients with favorable risk disease, where NCCN guidelines include both IO-TKI combinations and, in select cases, TKI alone. Dr. Wulff and Dr. Geynisman discuss how the treatment landscape has evolved, with IO-based combinations now preferred for most patients due to improved efficacy outcomes. However, the panel highlights that TKI monotherapy may still have a limited role in carefully selected patients, such as those with indolent disease, lower tumor burden, or contraindications to immunotherapy. They also note considerations around toxicity, patient preference, and comorbidities when deciding whether to avoid IO-based regimens. The discussion emphasizes that while TKI monotherapy is used less frequently in modern practice, it remains a reasonable option in specific clinical scenarios, reinforcing the importance of individualized treatment selection in favorable-risk advanced renal cell carcinoma.