Roundtable Roundup: Polling Physicians on Use of Frontline Therapies in RCC

CASE SUMMARY

A 59-year-old Black woman received a diagnosis of clear cell RCC. She underwent left total nephrectomy in December 2019. Nine months later, she developed metastatic disease to bilateral lungs, mediastinum (35 × 38 mm), and retroperitoneal lymph nodes. She was diagnosed with stage IV RCC, clear-cell histology, with metastases to lung and retroperitoneum. Her Karnofsky performance status score was 90%. Her hemoglobin was 11.1 g/dL, and her corrected calcium, neutrophils, and platelet levels were within normal limits.

“A decision was made to initiate systemic therapy. What frontline therapy are you most likely to choose for this patient?”

“All these combinations were compared against the same historical standard of sunitinib [Sutent]. The makeup of the trials was fairly similar; they had the same control arm. I think there’s at least enough of a rationale to compare them in some capacity.”

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_{7. Powles T, Choueiri TK, Burotto M, et al. Final overall survival analysis and organ-specific target lesion assessments with two-year follow-up in CheckMate 9ER: Nivolumab plus cabozantinib versus sunitinib for patients with advanced renal cell carcinoma. J Clin Oncol. 2022;40(suppl 6):350. doi:10.1200/JCO.2022.40.6_suppl.350}

_{8. Motzer R, Alekseev B, Rha SY, et al. Lenvatinib plus Pembrolizumab or Everolimus for Advanced Renal Cell Carcinoma. N Engl J Med. 2021;384(14):1289-1300. doi:10.1056/NEJMoa2035716}

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