Selecting Appropriate Treatments for Patients With Unresectable Kidney Cancer

Elizabeth Wulff-Burchfield, MD, assistant professor, Divisions of Medical Oncology and Palliative Medicine and medical director of Palliative and Geriatric Oncology Services, The University of Kansas Health System, advises physicians on how to make appropriate treatment decisions for patients with unresectable kidney cancer.

Treatment decisions should primarily depend on several patient characteristics, such as their functional status, goals for treatment, and tolerance for medical burden, Wulff-Burchfield says. Should the patient’s goal be to pursue more aggressive care and systemic therapy in order to both achieve good responses and improve symptom burden, she says she would prioritize treatment based on overall responses rates.

For patients who are more medically frail, or have comorbidities putting them at a higher risk for a rapid decline in function status or overall well-being, it is reasonable to consider a single-agent tyrosine inhibitor, according to Wulff-Burchfield. If a patient can tolerate more aggressive care, it would be appropriate to use a tyrosine kinase inhibitor in combination with an immune checkpoint inhibitor.