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Changes in Treatment Approach
Changes in Treatment Approach
Changes in Treatment Approach
Evolution of first-line therapy has created uncertainty in how best to treat patients with rrRCC20,21
There are limited data
for sequencing post
immune checkpoint
inhibitor treatments
for highly refractory RCC patients
Sequencing and combining treatments requires consideration of overlapping class effects, strategically withholding drugs, alternating therapeutic classes, washout periods, and other variables and approaches9,14,21
Sequencing for Later Line
Myriad factors to consider
As data evolve, tolerability and target selectivity represent important considerations in sequencing treatment decisions. Within the VEGFRi class, which includes target-specific and -nonspecific drugs, agents may be differentiated by their5,6,22-24:
- on-target potency
- selectivity
- bioavailability
- Class-related off-target adverse events are reported often in less selective VEGFR TKIs (ie, fatigue, palmar-plantar erythrodysesthesia syndrome, and diarrhea)3,6,23,25
- Analysis of VEGFRi AE incidence as a surrogate for efficacy found neutropenia and hypertension were independent biomarkers of efficacy, predicting improved outcomes even among poor-risk patients23,26