Evolving Renal Cell Carcinoma Treatment Paradigm

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The treatment of patients with renal cell carcinoma (RCC) remained essentially unchanged between the 1980's and the early 2000's, explains Nicholas J. Vogelzang, MD. At this point, sorafenib and sunitinib gained FDA approval followed by an onslaught of other TKIs and mTOR inhibitors. Following this explosion of new therapies, clinical trials began to assess optimal therapeutic sequences and dosing strategies, with some success, notes Vogelzang.

Now, in a similar explosion of treatments, the PD-1 and PD-L1 inhibitors are beginning to show promise as treatments for patients with RCC, explains Vogelzang. Moreover, these agents could potentially be combined or given sequentially with established TKIs, further enhancing outcomes.

The next challenge in the treatment of RCC will be the determination of where all of these agents fit together in the treatment paradigm, notes Vogelzang. TKIs have been explored in the adjuvant setting, with limited success; however, immunotherapy could have a role in this setting. To address this, clinical trials have been established to explore the immune checkpoint inhibitors as adjuvant therapies for patients with RCC, Vogelzang states.