Factors for Consideration in RCC Treatment Decision-Making

Chung-Han Lee, M.D.: It’s important to have a strong discussion with the patients about their own goals with their treatment and their feelings about risk. When we compare these two types of approaches, whether you do two immunotherapies or a tyrosine kinase inhibitor and an immunotherapy, the combination of two immunotherapies has a longer track record. They were approved before some of the new oral and IV [intravenous] combinations were around. They have a track record demonstrating that some people can have what we call durable responses. At four years out, they haven’t needed to switch to any other types of treatment.

However, the potential risk related to that type of approach is that the number of patients who respond is relatively less than the number of patients who have what we call primary progression of disease. At that first scan, the disease seems to grow in the 20%-to-25% range, and there’s a slightly higher risk of developing autoimmune toxicities. It’s weighing those types of risk factors.

The different tyrosine kinase inhibitor plus immunotherapy approaches have been associated with high levels of objective response in general. A high percentage of people have significant shrinkage of their disease. However, they don’t have that track record to say how durable this response may end up being. We need longer follow-up to try to understand that in comparison with all the different tyrosine kinase inhibitor and immunotherapy approaches, with four things available for your physician to think about.

There’s going to be a lot of discussion about why physicians pick one approach or another. Things to consider would be the response rates, the duration of survival, the toxicity you might expect from these different regimens and how difficult it’s going to be to manage these regimens. Each regimen has a bit of subtlety with regard to which to choose and which may be most suitable for you, pivoting a little toward thinking about the toxicity end of it.

Transcript edited for clarity.