Advanced Renal Cell Carcinoma: Selecting First-Line Combinations and Managing Long-Term Toxicity

In this segment, the discussion centers on treatment selection between immune-based combinations and targeted therapy–based combinations in advanced renal cell carcinoma. Dr. Brian Rini explains that treatment choice is often guided by disease burden and pace, with combination approaches including targeted therapy favored in patients requiring more rapid disease control, particularly those with higher tumor volume or symptomatic disease. In contrast, immune-based combinations may be preferred in patients with lower disease burden or specific histologic features, such as sarcomatoid differentiation, where durable responses may be more likely. The panel also highlights the absence of predictive biomarkers, emphasizing that treatment decisions remain largely based on clinical judgment. Additionally, the conversation addresses the challenge of long-term toxicity, particularly with targeted therapies, where prolonged use may impact patient quality of life. Both Dr. Rini and Dr. Elizabeth Plimack discuss practical strategies such as treatment interruptions or discontinuation to improve tolerability while maintaining disease control in advanced renal cell carcinoma.