Sequencing After First-Line Progression in Advanced Renal Cell Carcinoma

In this segment on advanced renal cell carcinoma, Dr. Wulff transitions the discussion to treatment sequencing after progression on first-line IO-based therapy. Dr. McGregor and Dr. Geynisman outline the key principles that guide their approach in the second-line setting, emphasizing the importance of prior treatment exposure and mechanism of action. The panel discusses how most patients progressing on IO-based combinations are typically transitioned to VEGFR TKI therapy, with agents such as cabozantinib playing a central role due to demonstrated efficacy across lines of treatment. They also highlight the need to consider duration of response to prior therapy, tolerability, and patient fitness when selecting subsequent treatment. The conversation underscores that sequencing in advanced renal cell carcinoma is not one-size-fits-all, and requires careful integration of clinical judgment, prior therapy history, and evolving evidence to optimize patient outcomes.