Novel Therapy in Metastatic RCC: An Evolving Treatment Landscape

Expert panelists share their perspective on novel and combination strategies being investigated in the setting of metastatic renal cell carcinoma.

Chung-Han Lee, MD, PhD:
What has you excited in terms of the future for RCC [renal cell carcinoma]?

Christine Anderson, NP: As I said before, when I started as a newer NP [nurse practitioner], these multiple combination regimens of the TKIs [tyrosine kinase inhibitors] and the immunotherapies were not so much available. I think the fact that these combination approaches are now happening on a routine basis and we’re seeing people live longer with this disease is very hopeful for the future of kidney cancer.

Chung-Han Lee, MD, PhD: I think that in terms of novel regimens and novel therapies, that we’ve gone to this era of first-line doublets. All the possible permutations of a tyrosine kinase inhibitor and an immune checkpoint inhibitor have probably been presented and actually have shown very robust results. Certainly, there’s a lot of interest in knowing whether we may benefit from triplet therapy, like trying to intensify some of the therapies. Certainly, the phase 3 clinical trial COSMIC-313 ended up meeting its primary end point. I think it still remains to be seen, with longer follow-up, what that’ll end up looking like. Other novel triplet therapies can be very, very interesting. We can think about whether or not drugs like belzutifan, which targets the HIF [hypoxia-inducible factor] pathway, may actually have very, very robust results in combination, or if there are other immune checkpoints that might actually be critical. Patty, you are also on the forefront of kidney cancer therapies. What has you excited right now?

Patricia Fischer, Research Nurse: It’s all exciting right now. It’s come so far along. It’s great to have all these therapies to choose from. I think genetics is important, which is sometimes done right at certain centers, being genetic profiling. To use that to better define what therapy each person should get.

Chung-Han Lee, MD, PhD: Of course. I think it’s very exciting. As we collect more and more molecular data to try to help us with treatment stratification, the development of those biomarkers are going to be incredibly important for people not only within the metastatic setting, but also for people in the adjuvant setting. I think that predicting, not only from a prognostic perspective, is going to be useful, but also predicting whether any of these changes that we can see can actually drive responses to stomach therapies or even predict whether or not they develop toxicity. Because again, whenever we talk about treatment, it’s not only what’s your chance of responding, but it’s also a combination of your chance of developing severe toxicities to some of these drugs.

Patricia Fischer, Research Nurse: You mentioned the adjuvant setting. Doing trials in the adjuvant setting is also exciting. To find a therapy that will prevent patients from recurring is something very exciting.

Chung-Han Lee, MD, PhD: Definitely. I think that being able to take a disease that used to have a relatively poor prognosis, and maybe not just relatively poor, but actually a quite poor prognosis—we’ve seen these rapid changes within the metastatic space with drugs within the adjuvants space, hopefully providing and increasing the chances of curability of their disease and preventing the development of metastatic disease is going to be critically important for our patients’ outcomes.

Transcript edited for clarity.

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