First-Line Treatment in Advanced Renal Cell Carcinoma

Dr. Martin Voss and Dr. Michael Serzan introduce the evolving treatment landscape for advanced renal cell carcinoma (RCC), emphasizing the importance of individualized first-line treatment selection. Dr. Serzan outlines the available immune checkpoint inhibitor and tyrosine kinase inhibitor-based combinations and explains how treatment goals should be established with each patient. While achieving a long-term, durable remission remains a key objective, factors such as symptom control, comorbidities, treatment-related toxicity, quality of life, and patient preferences also influence therapeutic decisions. The experts discuss the relative strengths and limitations of immune checkpoint inhibitor plus immune checkpoint inhibitor and immune checkpoint inhibitor plus tyrosine kinase inhibitor approaches. They highlight the durable responses observed with nivolumab plus ipilimumab, including the possibility of treatment-free intervals for selected patients, while noting concerns regarding toxicity and primary progressive disease. The discussion also addresses the early disease control and high response rates associated with immune checkpoint inhibitor plus tyrosine kinase inhibitor regimens and the importance of considering these differences when selecting first-line therapy for patients with advanced RCC.