The Changing Landscape of Management of Metastatic Renal Cell Carcinoma: Current Treatment Options and Future Directions

Opinion statementFor the practicing clinician, the dilemma becomes how most appropriate to sequence the aforementioned regimens. It is challenging to be dogmatic, as there are no comparative studies juxtaposing novel front-line options directly —all of the available studies utilize a comparator arm of sunitinib. With this in mind, the selection of front-line therapy with a patient with mRCC should involve a thorough discussion of both efficacy and safety of available options. The oncologist must also weigh their ability to manage complex immune-related adverse events that can emerge from checkpoint inhibitors, particularly with dual regimens such as nivolumab/ipilimumab. For the patient with good-risk disease, VEGF-directed therapies should remain a component of treatment. The data from CheckMate-214 does not support the use of niv olumab/ipilimumab in this setting, and in fact suggests superiority with the approach of VEGF-TKIs. Until regulatory decisions have been made around bevacizumab/atezolizumab and axitinib/avelumab, sunitinib and pazopanib remain options for patients with good-risk disease, although cabozantinib shoul d be a consideration as well. Although the CABOSUN study did not include patients with good-risk disease, it is important to bear in mind that this was more of a pragmatic decision—inclusion of these patients in the original design could have potentially lengthened the extent of necessary follow-u p. From a mechanistic standpoint, there is no reason...
Source: Current Treatment Options in Oncology - Category: Cancer & Oncology Source Type: research