Post-Immunotherapy Treatment in Advanced Renal Cell Carcinoma

Dr. Voss and Dr. Serzan discuss treatment strategies in the post-immunotherapy setting for advanced clear cell renal cell carcinoma (RCC), focusing on whether immune checkpoint inhibition should be continued after progression. Dr. Serzan reviews two phase 3 studies, CONTACT-03 and TiNivo-2, which prospectively evaluated continued immune checkpoint inhibition in combination with a tyrosine kinase inhibitor versus TKI therapy alone following prior immunotherapy. He notes that neither study demonstrated an improvement in progression-free survival with continued immunotherapy, while the cabozantinib plus atezolizumab arm in CONTACT-03 was associated with greater toxicity than cabozantinib alone. Dr. Serzan therefore describes avoiding routine continuation or rechallenge with anti-PD-1/PD-L1 therapy after progression on prior immunotherapy. He also discusses the TiNivo-2 subgroup in which patients had received an intervening non-immunotherapy treatment before rechallenge, noting that this treatment break did not identify a clear benefit from renewed immunotherapy. Dr. Voss agrees that subgroup analyses have not established a patient population that consistently benefits from continued PD-1/PD-L1-based combinations after progression.