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Genitourinary Cancers • Medical Oncology • NCI-CCC Tumor Board Question • Duke • NCI-CCC GU Tumor Board Question • Duke GU Tumor Board
What second line therapy would you use for metastatic clear cell RCC after a 6-12 month response to ipilimumab/nivolumab followed by development of multiple bone metastases but stable soft tissue disease?
Ex: TKI alone, TKI + checkpoint inhibitor, checkpoint inhibitor alone, TKI + mTOR inhibitor. Please specify drug regimen, if applicable.
Answer from: Medical Oncologist at Academic Institution
Great question. Options include agents such as cabozantinib, lenvatinib/everolimus, and axiitnib. I favor cabozantinib in this setting because of its track record of activity in bony metastases in the METEOR trial and other studies. Also, please keep in mind the availability of CONTACT-3, which is a...
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Answer from: Medical Oncologist at Academic Institution
I will diverge from @Sumanta K. Pal's answer a bit. I'm not as convinced about cabo's enhanced activity in bone mets. I think much of that is derived from METEOR when cabo was compared to an mTOR agent, not another VEGFR inhibitor. Nonetheless, single agent TKI is SOC here (perhaps with SBRT to bone...