Biomarkers and Data Gaps in First-Line RCC

Moshe C. Ornstein, MD, MA, of Cleveland Clinic and Terence W. Friedlander, MD, of UCSF Helen Diller Family Comprehensive Cancer Center describe the data that would sharpen first-line decisions in advanced renal cell carcinoma (RCC), in a discussion moderated by Elizabeth R. Plimack, MD, MS, of Fox Chase Cancer Center. Dr Ornstein wants biomarkers that predict response to dual immunotherapy vs immunotherapy plus a tyrosine kinase inhibitor (TKI) and that flag early resistance, from neutrophil and lymphocyte counts to kidney injury molecule-1 (KIM-1) and RNA sequencing. He also wants to know which patients can receive less, whether a TKI alone, single-agent immunotherapy, a shorter course, or systemic therapy followed by surgery or radiation to remaining sites. Dr Friedlander calls KIM-1 an exciting biomarker but says it is not ready for routine use or guidelines. He points to studies pairing hypoxia-inducible factor inhibitors such as belzutifan with older TKIs such as lenvatinib.