Strategies for Sequencing Therapies in Renal Cell Carcinoma

EP: 1.CLEAR Trial: Lenvatinib Plus Pembrolizumab in Advanced Renal Cell Carcinoma

EP: 2.Recent Data on Lenvatinib Plus Pembrolizumab in Advanced RCC

EP: 3.Clinical Trial Data Updates in Advanced Renal Cell Carcinoma

EP: 4.Clear Cell RCC: Strategies for Selecting Appropriate Frontline Treatment

EP: 5.Second-Line Treatment Options for Patients With Clear Cell RCC

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EP: 6.Strategies for Sequencing Therapies in Renal Cell Carcinoma

EP: 7.Safety Profiles of Treatment Regimens for Clear Cell RCC

EP: 8.Future Outlook of Treatment for Clear Cell RCC

EP: 9.RCC Histologies: Clear Cell vs Non–Clear Cell

EP: 10.Updates from ASCO 2023 for Non–Clear Cell RCC

EP: 11.Emerging Therapies in Non–Clear Cell Renal Cell Carcinoma

Transcript:

Robert J. Motzer, MD: In terms of the way my own thinking with regard to sequencing therapy and in this new era where IO [immuno-oncology] combinations are first-line treatment, for the most part, many of my patients were treated with ipilimumab-nivolumab. And so at the time of progression, I offer patients a tyrosine kinase inhibitor. I would say that in general, the one most commonly offered is cabozantinib because that is the TKI [tyrosine kinase inhibitor] that is generating data that are quite impressive in this setting. In the CONTACT-03 trial [NCT04338269], the median progression-free survival was about 10 months and the response rate was about 30%. That has demonstrated efficacy in this setting, and that’s generally my go-to regimen for patients not only who have had ipilimumab-nivolumab but also TKI-IO combinations like lenvatinib-pembrolizumab or axitinib-pembrolizumab.

If a patient has had prior cabozantinib and has been treated with cabozantinib and nivolumab in the first line, then I certainly would not go back and give cabozantinib in the second line. In those patients, I generally use a different program, and the program that I would recommend is lenvatinib plus everolimus. Lenvatinib plus everolimus is another option in the second or third line. And part of the choice in sequence therapy depends on what the patient has received in the first line and also the tolerability of that program in the first line, and that’s what helps me select second- and third-line therapy.

I’d like to add to the point regarding what the best sequence is in the second or third line. Although options are available, like cabozantinib, based on a lack of data, that really is a setting where we should think clinical trial. Clinical trials are ongoing in that space. They’re looking at novel combinations. They’re looking at novel agents and approaches. And so I think that particular setting is one where we should think: Is there a clinical trial to offer this patient?

Transcript is AI-generated and edited for clarity and readability.