Dr. Ho on First-Line TKI Monotherapy in mRCC

Thai H. Ho, MD, PhD, assistant professor of medicine, Mayo Clinic, discusses the role of TKI monotherapy in the first-line treatment of patients with metastatic renal cell carcinoma (mRCC).

The phase II CABOSUN trial demonstrated an improvement in progression-free survival (PFS) and overall survival with cabozantinib (Cabometyx) versus sunitinib in patients with poor- or intermediate-risk disease. In the phase III CheckMate-214, KEYNOTE-426, and JAVELIN Renal 101 trials, investigators reported at least a PFS benefit compared with sunitinib with the combinations of ipilimumab (Yervoy)/nivolumab (Opdivo), pembrolizumab (Keytruda)/axitinib (Inlyta), and axitinib/avelumab (Bavencio), respectively, in patients with advanced RCC.

As such, sunitinib should not be considered for first-line treatment of mRCC, says Ho. Though, the CABOSUN data suggest that cabozantinib could be an option for patients who are intolerant of or ineligible for immunotherapy, concludes Ho.