Second-Line Utilization and Evolving Options in Advanced Renal Cell Carcinoma

In this segment on advanced renal cell carcinoma, Dr. Ornstein explores real-world transition rates from first-line to subsequent lines of therapy, asking how often patients reach second- and third-line treatment in clinical practice.

Dr. Friedlander highlights that real-world data suggest nearly half of patients may not receive second-line therapy, particularly outside academic settings, where patients may be older, more frail, or experience rapid disease progression. He contrasts this with his own practice, where a higher proportion of patients are able to proceed to second-line treatment. He reinforces the importance of optimizing first-line therapy, given that some patients may not receive additional treatment.

The discussion then shifts to second-line options, including VEGF receptor targeted therapy monotherapy, lenvatinib with everolimus, and emerging combinations. Dr. Friedlander also discusses evolving data with newer regimens and notes that ongoing developments may continue to reshape sequencing strategies in advanced renal cell carcinoma.