Case-Based Sequencing After IO in Advanced Renal Cell Carcinoma

In this case-based segment on advanced renal cell carcinoma, Dr. Ornstein presents a patient with intermediate-risk disease who experienced progression after 14 months of frontline dual immune checkpoint inhibitor therapy. He highlights the importance of interpreting prior treatment response and clinical status when selecting second-line therapy.

Dr. Singer discusses how the duration of response to prior therapy informs treatment decisions, noting that this patient achieved meaningful benefit, suggesting a disease biology that remains responsive to systemic therapy. For a fit patient seeking the most effective option, he favors regimens with strong efficacy data, such as lenvatinib with everolimus or cabozantinib, referencing randomized data showing improved progression-free survival with combination therapy. Dr. Ornstein adds that while efficacy is critical, toxicity considerations must also be weighed, particularly in the refractory setting. The discussion emphasizes balancing efficacy and tolerability while individualizing treatment selection in advanced renal cell carcinoma.