Pedro Barata, MD, MSc, FACP

An expert discusses using sequence therapies based on disease progression, patient factors, and resistance mechanisms. After a first-line tyrosine kinase inhibitor plus immune checkpoint inhibitor (TKI +  ICI) regimen, preferred subsequent-line options include alternative TKIs, chemotherapy, or combination strategies, tailored to patient response and tolerability.

An expert discusses how third line (3L) systemic therapy for metastatic renal cell carcinoma (mRCC) is guided by prior treatments, patient comorbidities, and drug-specific profiles. Options include tyrosine kinase inhibitors (TKIs; eg, tivozanib, cabozantinib), mTOR inhibitors (eg, everolimus), and immune-oncology– based approaches. Efficacy, tolerability (grade 3/4 adverse events [AEs]), and pharmacokinetic (PK) differences drive selection. Dose modifications, such as for tivozanib and lenvatinib/everolimus, balance efficacy and safety. Selection prioritizes sequencing strategy, with evidence (eg, Pal 2022) supporting reduced-dose efficacy.

An expert discusses how efficacy and safety data from trials such as METEOR, TIVO-3, TiNivo-2, and LITESPARK-005 guide third line (3L) renal cell carcinoma (RCC) treatment. Differences in trial populations, evolving long-term trends, and prior immune checkpoint inhibitor (ICI) use impact applicability. CONTACT-03 and TiNivo-2 provide key insights, and real-world data and patient-reported outcomes refine clinical decision-making. Community oncologists should critically assess study limitations and evolving evidence when selecting therapy.

A panelist discusses how, based on the NCCN guidelines for kidney cancer, third-line treatment options for this patient include cabozantinib, lenvatinib plus everolimus, tivozanib, and everolimus monotherapy. Clinical trials and best supportive care remain important considerations at this stage.

An expert discusses how, in third line (3L) therapy, goals shift from optimal disease control to managing treatment-resistant disease while preserving quality of life. Unlike 2L therapy where significant disease control is still expected, 3L aims for modest clinical benefit, symptomatic relief, and stabilizing disease progression. Treatment choices now heavily prioritize tolerability, patient preferences, and palliative considerations.

An expert discusses the patient case of a 65-year-old woman who has presented to the emergency department with abdominal pain. The patient’s previous medical issues include a duodenal ulcer that she experienced 10 years ago. The patient is a smoker, and her current medication is lansoprazole (30 mg). After the patient begins to present worsening lower back pain, a CT scan shows lytic lesions in her thoracic spine and rounded lesion in both lungs. A biopsy of the lung lesion confirms clear cell renal cell carcinoma (RCC) with sarcomatoid differentiation.

A key opinion leader addresses the persistent challenges and unmet needs in the management of advanced urothelial carcinoma, while offering their insight into the future direction and potential advancements within this rapidly evolving field of oncology.

A leading medical authority shares their hands-on experience with sacituzumab govitecan, focusing on the primary toxicity concerns, such as diarrhea and neutropenia, and outlining effective management strategies to mitigate these adverse effects and optimize patient care.

A key opinion leader delves into the intricacies of second-line and third-line treatment sequencing for patients with progressive disease, addressing the appropriate timing for repeat testing and elaborating on the critical factors that inform their personalized treatment approach.

A medical professional outlines their preferred first-line treatment strategy for managing patients diagnosed with metastatic urothelial carcinoma, providing valuable insights into their clinical decision-making process.

A leading expert in the field shares their insights on the specific biomarkers they evaluate, such as Trop2, FGFR, and PD-L1, and the optimal timing for conducting these tests based on their clinical experience and patient management strategies.

A key opinion leader offers a comprehensive overview of the present landscape of molecular testing in metastatic urothelial cancer, elaborating on how advancements in molecular testing have shaped his clinical practice and expressing optimism for their future incorporation into the National Comprehensive Cancer Network (NCCN) guidelines.

A urology expert elucidates the collaborative relationship between medical oncology and urology in terms of diagnostic testing, treatment strategies, and patient referrals, while underscoring the crucial role of a multidisciplinary approach in maximizing positive patient outcomes.

A key opinion leader presents a case study of a 73-year-old male patient diagnosed with metastatic urothelial carcinoma, highlighting the associated risk factors and challenges in establishing an accurate diagnosis.