Case-Based Second-Line Strategy After IO in Advanced Renal Cell Carcinoma

In this case-based segment on advanced renal cell carcinoma, Dr. Ornstein presents a clinical scenario of a patient with disease progression after frontline dual immune checkpoint inhibitor therapy, emphasizing the need to individualize second-line treatment decisions in the absence of certain emerging approvals.

Dr. Friedlander discusses his approach, noting that treatment selection remains guided by disease aggressiveness, IMDC risk, and overall tumor burden. For patients with more aggressive features, such as bone or brain metastases or high disease volume, he favors more intensive approaches, including combination strategies. In contrast, for patients with less aggressive disease who are TKI-naïve, he considers VEGF receptor targeted therapy monotherapy, highlighting that some patients can achieve durable responses with this approach. He emphasizes balancing efficacy with tolerability and aligning treatment with patient goals, including quality of life considerations. Dr. Ornstein adds that commonly used options in this setting include cabozantinib or lenvatinib with everolimus, reinforcing a case-by-case approach.