Advanced, Metastatic Kidney Cancer: Favorable and Very Favorable Risk Stratification

Karine Tawagi, MD, of the University of Illinois College of Medicine, considers how the “favorable” and “very favorable” risk categories alter her approach to patient management for advanced or metastatic RCC.

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Dr. Tawagi: Today, we saw a real-world abstract presented on very favorable IMDC risk category. These are patients that are more than 3 years from time of diagnosis to initiation of systemic therapy with no visceral metastasis. They had a nephrectomy and then had indolent disease for a period of time and are only starting systemic therapy at least 3 years out.

Researchers found that patients in the group that received doublet immunotherapy had a worse overall survival than those receiving the TKI regimens. It was a small cohort, and we do not know the full circumstances under which patients were recommended to undergo IO/IO. But in general, we know that patients with favorable and very favorable risk category are recommended to have a TKI-based regimen.

IO/TKI is the option generally for favorable risk in the guidelines. There is weaker evidence for IO/IO in that setting, perhaps because the high rate of toxicity that you can see with IO/IO. Therefore, in the current space where we now have favorable and very favorable risk categories, we are still considering TKI-based regimens.

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