Patients with renal cell carcinoma (RCC) whose disease has progressed after initial immunotherapy or tyrosine kinase inhibitor (TKI) therapy have more second-line treatment options than ever before.
Enrique Grande, MD, PhD, MSC, MD Anderson Cancer Center Madrid, Spain, shared his thoughts on therapy sequencing for patients with RCC in a conversation with Karan Jatwani, MD, of George Washington University Hospital, Washington, DC, at the 2025 American Society of Clinical Oncology Annual Meeting.
In the second-line setting, Dr. Grande opts for cabozantinib after dual immunotherapy or immunotherapy plus TKI, unless cabozantinib combined with nivolumab was used upfront.
“We have belzutifan as well. I think belzutifan is a very reasonable option, particularly if you are not looking for a response, but you are looking for an improvement in the quality of life,” Dr. Grande said.
Current studies have shown promise in RCC treatment with a frontline immunotherapy combination, followed by cabozantinib and potentially belzutifan. Although it’s not yet a standard sequential strategy, experts are excited about the encouraging data.
When considering other TKI therapy options, it may come down to patient preference based on treatment goals. If a patient wants to preserve quality of life, Dr. Grande recommends tivozanib over the combination of lenvatinib plus everolimus. However, a rapid, deeper tumor response is typically experienced with the use of lenvatinib-everolimus.
