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Agarwal Addresses Sequencing Challenges in Kidney Cancer

Caroline Seymour
Published: Tuesday, Jun 19, 2018

Neeraj Agarwal, MD

Neeraj Agarwal, MD
The FDA approval of cabozantinib (Cabometyx) in December 2017 and the subsequent approval of nivolumab (Opdivo) and ipilimumab (Yervoy) in April 2018 for the frontline treatment of patients with renal cell carcinoma (RCC) has broadened available therapeutic options for patients.

State of the Science Summit™ on Genitourinary Cancers, Agarwal, associate professor, Division of Oncology, Department of Medicine, University of Utah School of Medicine, Huntsman Cancer Institute, discussed his preferred sequencing strategies for treating patients with kidney cancer, and ongoing immunotherapy research in the field.

OncLive: Can you speak to the importance of sequencing agents in kidney cancer?

Agarwal: Over the last 10 years, especially the last 3 years, multiple agents have been approved in the treatment of patients with metastatic RCC. This is great news for patients, but it also creates a lot of challenges for clinicians and oncologists.

What are the patient factors that you take into consideration in determining first- and second-line therapy?

The most important resource I use for treatment decision-making is the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk factors. In my view, those are presently the most commonly recognized risk factors for prognostication and drug selection. I use them for first line, second line, or later lines of therapy. 

What are some unanswered questions in kidney cancer?

Until last year, the first-line agents were sunitinib (Sutent) or pazopanib (Votrient) and, for some patients, the mTOR inhibitor temsirolimus. Within the last 5 months, the FDA approved the combination of ipilimumab and nivolumab, as well as cabozantinib as a single agent, in the first-line setting. Cabozantinib was previously approved in the second-line setting.
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