Overview of the First-Line ccRCC Treatment Landscape
Panelists discuss current strategies for first-line treatment sequencing in renal cell carcinoma (RCC), emphasizing immunotherapy-based combinations tailored to disease burden and patient characteristics, while highlighting the importance of multidisciplinary care, real-world experience, and clinical trial data in guiding personalized, patient-centered decisions.
In this expert panel discussion from the CancerNetwork® Training Academy, leading oncologists evaluate current strategies for sequencing therapies in RCC, particularly focusing on first-line treatment decisions and their downstream implications. The panel emphasizes the use of immunotherapy-based combinations as the standard of care in advanced clear cell RCC. These regimens fall into 2 main categories: dual immunotherapy (IOIO), such as ipilimumab plus nivolumab, and combinations of IO with tyrosine kinase inhibitors (IOTKIs), including agents like axitinib, cabozantinib, or lenvatinib paired with pembrolizumab or nivolumab. Each combination has demonstrated superiority over the historical standard, sunitinib, with varying profiles in terms of response rates, durability, and toxicity.
The discussion highlights the importance of personalizing treatment based on disease burden, symptom severity, and patient characteristics. IOIO regimens are often preferred for patients with lower disease burden or certain histological features, offering long-term benefit with reduced chronic toxicity. Conversely, IOTKI combinations are favored in symptomatic patients or those with a high disease burden due to their faster and higher response rates—some exceeding 70%. Clinicians also consider pharmacologic aspects such as the half-life of TKIs and administration convenience when tailoring treatment. For instance, axitinib’s short half-life allows for quick dose adjustments, whereas cabozantinib’s once-daily dosing can enhance adherence.
Importantly, the panel underscores the collaborative nature of RCC management, stressing the role of patient education, multidisciplinary coordination, and proactive adverse event management in treatment success. Although treatment guidelines like the National Comprehensive Cancer Network provide a useful reference, the panelists emphasize clinical trial evidence, practical experience, and individual patient factors in decision-making. Overall, the session reflects a nuanced and evidence-based approach to RCC treatment sequencing, balancing efficacy, safety, and patient-centered care.
Newsletter
Stay up to date on recent advances in the multidisciplinary approach to cancer.
