Dr. Hutson on how he treats advanced RCC patients who progress on first-line lenvatinib/pembrolizumab

In this video, Thomas E. Hutson, DO, PharmD, FACP, explains his treatment strategy for subsequent lines of therapy if one of his patients with advanced renal cell carcinoma (RCC) progresses on or after receiving the combination of lenvatinib (Lenvima) and pembrolizumab (Keytruda) in the first-line setting.

At the 2023 ASCO Annual Meeting, Hutson presented updated findings from the phase 3 CLEAR study (NCT02811861) showing that, at median follow-up of 4 years, lenvatinib plus pembrolizumab continued to have overall survival and progression-free survival benefits over sunitinib (Sutent) in patients with advanced RCC.¹

Hutson is the director of the urologic oncology program at Baylor University Medical Center in Dallas, Texas.

Transcript

This is a common, clinically relevant question. So the goal at the end of the day is to get exposure of your patient [with renal cell carcinoma] to as many of the most active agents as possible, and not withholding any therapy to later lines. We've shown, historically, that a lot of patients succumb to the illness and don't make it to lines; so, we want to make sure that we're choosing the most active regimen possible. So if we start off with a lenvatinib-containing regimen—and we know lenvatinib plus pembrolizumab is a very strong regimen—that would leave agents such as cabozantinib (Cabometyx), and agents such as tivozanib (Fotivda) as options for that second- and third-line setting. So in my practice, I would be choosing cabozantinib as a second-line agent and tivozanib as a third-line agent.

Transcript has been edited for clarity.

Reference

1. Motzer RJ, Porta C, Eto M, et al. Final prespecified overall survival (OS) analysis of CLEAR: 4-year follow-up of lenvatinib plus pembrolizumab (L+P) vs sunitinib (S) in patients (pts) with advanced renal cell carcinoma (aRCC). J Clin Oncol 41, 2023 (suppl 16; abstr 4502). doi: 10.1200/JCO.2023.41.16_suppl.4502