Expert Panel Shares Forward-Looking Thoughts on RCC Treatment, Clinical Trials

A roundtable discussion, moderated by Brad McGregor, MD, focused on the latest data in RCC treatment and management, including data from the American Society of Clinical Oncology Genitourinary Cancers Symposium 2024. Dr. McGregor was joined by Rana McKay, MD; Elizabeth Wulff-Burchfield, MD; and Alan Tan, MD.

In the final segment of the roundtable series, the panel shared their excitement for the road ahead in kidney cancer, including LITESPARK trials, the potential for triplet therapy, and more.

Watch previous segments in this series.

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Dr. McGregor: I think we’re all really excited about what we saw at the meeting this year. If you look ahead to maybe the 21st [ASCO GU], what are some of the things that are happening right now in kidney cancer that you’re looking forward to in the future?

Dr. Tan: We haven’t really had a good triplet regimen that’s been well tolerated. LITESPARK-012 I’m really intrigued because we’re looking at a HIF2-alpha triplet and that may be a game changer. I don’t know. There’s also LITESPARK-011 in the refractory setting. Even though belzutifan is a great agent, well tolerated, but the onset of action is not all that quick. If you have a patient with a relatively symptomatic relapse, I think you probably need a TKI along with that. That’s looking at lenvatinib plus belzutifan compared to a cabozantinib as a comparator.

Dr. McKay: In the adjuvant setting, we’ve got LITESPARK-022 looking at belzutifan plus pembrolizumab that’s almost done with accrual. I think that’s going to be really an important study to also help better optimize in the localized setting. I think there was a huge call during the sarcomatoid variant histology session that we really need to do a better job of designing trials for our variant histology tumors and really trying to understand how we can apply therapies that better target the disease biology instead of just clustering everything into 1 and hoping that it works.

Dr. Wulff-Burchfield: I agree. To that end, I don’t think it’ll be at the 21st [ASCO GU] symposium, but having seen the beautiful KETNOTE-564 overall survival data, it also feels like a call to action for us to serve our patients with these variant histology kidney cancers better. I do believe that there is a trial that will be coming through the Cooperative Groups looking at adjuvant IO versus IO/TKI versus surveillance for patients with papillary renal cell carcinoma or multiple variant histologies. But I think that’s something that feels clearly needed for those folks.

Dr. McGregor: To that point of triplets, I think we’ll look to the maturation of COSMIC-313. Do we see something there? Is there going to be OS?I think that’ll be interesting to see. I look forward to the new challenges.  With all these developments that have happened, now we have adjuvant pembrolizumab that’s readily available. How are we going to then change frontline therapy? How is that going to augment things? Hopefully trials like TiNivo-2 may definitively answer this answer of maintenance therapy or not.

Dr. McKay: I think we’re going to have new terminology almost like we do with BCG refractory, BCG resistant. Are they IO refractory? Like depending on the kinetics of how somebody may or may not progress post-adjuvant dictating how that may impact retreatment with IO in the frontline setting. I think we really don’t know.

Dr. Tan: Good problem to have.

Dr. McGregor: I want to thank everyone; it’s been a great discussion.