Bone Metastases, Prognosis, and Treatment Selection

Moshe C. Ornstein, MD, MA, of Cleveland Clinic explains to Elizabeth R. Plimack, MD, MS, of Fox Chase Cancer Center why bone metastases do not drive his first-line regimen choice in advanced renal cell carcinoma (RCC). He describes a long-standing perception that one tyrosine kinase inhibitor (TKI) might be favored over another for bone disease, a view he suspects came from another disease setting. Subgroup analyses of lenvatinib plus pembrolizumab and of cabozantinib plus nivolumab have reassured him that these combinations improve outcomes over the control arm even in patients with bone metastases. He treats bone and liver involvement like any other site when choosing therapy, but not when discussing prognosis, telling patients with brain, bone, or liver metastases that he is a little more worried while pointing to the activity of current combinations in these previously challenging sites. Dr Plimack summarizes that metastatic site informs the conversation with the patient more than the treatment decision itself.