Dr. George on Sequencing in Renal Cell Carcinoma

Daniel J. George, MD, professor of Medicine and Surgery, member, Duke Cancer Institute, discusses sequencing in renal cell carcinoma (RCC).

There are many factors to consider when selecting and sequencing therapy, one of which is risk status. Good-risk patients tend to have a manageable tumor burden and live a long time, says George. However, many good-risk, low-volume patients can get by with active surveillance. Intermediate risk comprises the largest risk category of RCC patients at about 60%, explains George. Physicians should take a proactive approach for these patients, as they can be unpredictable. Typically, an immunotherapy-based regimen is a suitable treatment option.

Treatment for patients with poor-risk disease depends on tolerability, states George. Many patients may require palliation, and drugs such as cabozantinib (Cabometyx) can result in very quick responses, which can be helpful. Some patients may have an overwhelming burden of disease, in which case palliation and supportive care take precedence.