Updates in the Treatment of Advanced RCC: Highlights from ASCO GU 2024

Elizabeth Plimack, MD, discusses the long term follow up data from the Checkmate 214 study evaluating nivolumab plus ipilimumab versus sunitinib in first line treatment of clear cell renal cell carcinoma, including overall survival, progression free survival, response rates, and safety data.

Benjamin Maughan, MD, PharmD, examines efficacy outcomes from the CLEAR trial of lenvatinib plus pembrolizumab vs sunitinib in metastatic clear cell RCC, including how overall survival, progression free survival, and response rates compare across different baseline tumor size groups.

Elizabeth Plimack, MD, reviews a network meta-analysis comparing progression free survival and overall survival outcomes for lenvatinib plus pembrolizumab versus other first line regimens for metastatic clear cell renal cell carcinoma across multiple trials.

The panelists summarize their approaches to choosing frontline treatment for advanced clear cell RCC, balancing long-term and short-term efficacy data on IO-IO versus IO-TKI regimens based on recent study results.

The panel discusses long-term data showing more limited benefit of IO-IO therapy versus TKI regimens for favorable risk RCC patients and implications for their risk-adapted treatment approach.

Expert panelists discuss the importance of rapid improvement within 24-72 hours with steroids for managing unpredictable immune-related toxicities that can occur with frontline IO-IO or IO-TKI regimens for patients with RCC.

Panelists discuss systemic therapy approaches for RCC patients presenting with brain, liver, or bone metastases, noting more limited efficacy of IO-IO therapy in brain metastases and tendencies to use IO-TKI therapy for aggressive or rapidly progressing disease.

Martin Voss, MD, reviews data updates from ASCO GU 2024 on the KEYNOTE-B61 study of lenvatinib + pembrolizumab in nccRCC in addition to real-world outcomes in patients with chromophobe RCC.

The panel discusses key learnings from recent studies in non-clear cell RCC subtypes and the need to better understand disease biology to develop optimized, histology-specific therapies rather than extrapolating clear cell treatment approaches.