Advancing RCC Treatment: Insights From Dr. Karine Tawagi

In the fourth panel of the Advancements in Oncology event, held on Saturday, June 1, The Oncology Brothers, Rahul Gosain, MD, MBA, and Rohit Gosain, MD, sat down with Karine Tawagi, MD, of the University of Illinois Chicago.

The discussion focused on advanced and metastatic stages of renal cell carcinoma (RCC), shedding light on current practices in clinics.

Favorable, Very Favorable Risk Stratification

The trio began with a conversation on real-world data presented at the 2024 American Society of Clinical Oncology Annual Meeting pertaining to patients classified as having “favorable” and “very favorable” RCC. Notably, “very favorable” patients, characterized by a diagnosis-to-systemic therapy interval of more than 3 years and absence of visceral disease postnephrectomy, were found to have worse overall survival when treated with doublet immunotherapy.

“To put someone through the toxicity of nivolumab-ipilimumab is a little bit challenging for someone who might have no symptom burden of disease,” Dr. Tawagi said. She advocated for tyrosine kinase inhibitor (TKI)-based regimens as the preferred choice for “favorable” risk patients.

Considerations for Second-Line Treatment

Dr. Tawagi then outlined strategies for second-line treatment options following TKI and immunotherapy combinations, stating, “We know based on CONTACT-03 from this meeting last year that there is no role of rechallenging with immunotherapy.”

She highlighted novel agents like belzutifan and tivozanib, noting, “We have increasing options.” The trio emphasized the importance of tailored approaches in the second-line setting.

First-Line Treatment Selection in Intermediate Poor-Risk RCC

In the context of first-line treatment for intermediate poor-risk RCC, Dr. Tawagi highlighted her preference of pembrolizumab/axitinib, particularly for clear cell histology cases. Variant histology, however, may warrant alternative combinations such as lenvatinib plus pembrolizumab or nivolumab plus cabozantinib. She mentioned the necessity of ongoing trials, such as the PDIGREE trial, in elucidating the efficacy of various immunotherapy (IO)/IO and IO/TKI combinations.

Considerations for Bone Metastatic Disease

Addressing the impact of bone metastatic disease on treatment selection, Dr. Tawagi acknowledged the potential responsiveness of cabozantinib-based regimens. While personal practice preferences often vary among clinicians, individualized treatment decisions based on patient factors and tolerability profiles are key.

View previous segments from this session.