First-Line IO-TKI Combination Treatment Regimens for Advanced RCC

A review of the first-line IO/TKI combination regimens available for advanced RCC and the factors considered in choosing an appropriate treatment.

Arnab Basu, MD: This was our first case on pembrolizumab and lenvatinib, and it would be good to review the first line IO/TKI [immuno-oncology/tyrosine kinase inhibitor] combination regimens approved for patients with advanced RCC [renal cell carcinoma], Dr Anakwah. The approved regimens are lenvatinib plus pembrolizumab, which this patient was on, and this is based on the CLEAR trial from 2021. The other regimens are axitinib and pembrolizumab, based on the Keynote-426 study from 2019; the cabozantinib and nivolumab combination based on CHECKMATE 9ER, also done recently; and axitinib and avelumab, based on JAVELIN Renal 101. Unfortunately, axitinib and avelumab have not demonstrated a survival benefit, and so generally, the first 3 are the ones that are preferred.

Indeed, Dr Anakwah, when choosing among these regimens, do you take into account any factors for making a choice between these regimens?

Shawnta Anakwah, MD: Yes, I do. I take into account the patient’s age, performance status, comorbid conditions, support system, patient preference, as well as factors about the tumor, like if they have a very high-grade component or if they’re intermediate risk, high risk vs low risk.

Transcript edited for clarity.

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