Disease Burden and Metastatic Sites in Advanced Renal Cell Carcinoma

Dr. Voss and Dr. Serzan discuss how disease burden and the location of metastases can influence first-line treatment selection in advanced renal cell carcinoma (RCC). Dr. Serzan describes a patient with extensive liver and symptomatic bone metastases for whom achieving rapid disease control was a major consideration. He explains his rationale for selecting lenvatinib plus pembrolizumab in that setting and describes early symptomatic improvement and substantial tumor shrinkage. Dr. Voss highlights the importance of considering the risk of primary progressive disease when treating patients with a high disease burden who may have limited opportunity to receive subsequent therapy. The discussion then turns to brain metastases, with Dr. Serzan describing his approach to CNS staging and surveillance and his preference in many cases for an IO-TKI regimen, particularly cabozantinib plus nivolumab, based on available retrospective intracranial response data. Dr. Voss adds perspective on evidence for cabozantinib and lenvatinib in patients with brain metastases, while emphasizing the individualized nature of regimen selection.