Risk Stratification and Frontline IO Strategy Selection in Advanced RCC

The program opens with introductions and transitions into a discussion of how clinicians approach first line treatment decisions in advanced renal cell carcinoma. The panel emphasizes that patients are increasingly managed as though living with a chronic disease, which makes thoughtful sequencing essential from the outset. Risk stratification remains foundational. IMDC criteria help categorize patients into favorable, intermediate, and poor risk groups, but clinical judgment extends beyond formal scoring systems.

Panelists highlight the importance of tumor histology, burden of disease, pace of progression, sites of metastasis, and symptomatology. Liver and bone metastases, rapid progression, and symptomatic disease often prompt consideration of more aggressive combination strategies. Performance status and comorbidities also meaningfully influence choice of IO plus IO versus IO plus TKI approaches.

The “eyeball test” is discussed as a practical component of decision making. Patients who appear frail or symptomatic may require faster disease control, while relatively asymptomatic individuals with limited burden may tolerate a strategy aimed at achieving durable remission. The panel agrees that immune checkpoint therapy forms the backbone of frontline treatment, but tailoring combination selection requires integrating biological risk with real world patient factors.