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A Syngeneic Mouse Model of Metastatic Renal Cell Carcinoma for Quantitative and Longitudinal Assessment of Preclinical Therapies
Published on: April 12, 2017
Second-line treatment for metastatic clear cell renal cell cancer: experts' consensus algorithms
C Rothermundt1, J von Rappard2, T Eisen3
1Department of Haematology and Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. christian.rothermundt@kssg.ch.
Background:
Second-line systemic treatment options for metastatic clear cell renal cell cancer (mccRCC) are diverse and treatment strategies are variable among experts. Our aim was to investigate the approach for the second-line treatment after first-line therapy with a tyrosine kinase inhibitor (TKI). Recently two phase III trials have demonstrated a potential role for nivolumab (NIV) and cabozantinib (CAB) in this setting. We aimed to estimate the impact of these trials on clinical decision making.
Materials And Methods:
Eleven international experts were asked to provide their treatment strategies for second-line systemic therapy for mccRCC in the current setting and once NIV and CAB will be approved and available. The treatment strategies were analyzed with the objective consensus approach.
Results:
The analysis of the decision trees revealed everolimus (EVE), axitinib (AXI), NIV and TKI switch (sTKI) as therapeutic options after first-line TKI therapy in the current situation and mostly NIV and CAB in the future setting. The most commonly used criteria for treatment decisions were duration of response, TKI tolerance and zugzwang a composite of several related criteria.
Conclusion:
In contrast to the first-line setting, recommendations for second-line systemic treatment of mccRCC among experts were not as heterogeneous. The agents mostly used after disease progression on a first-line TKI included: EVE, AXI, NIV and sTKI. In the future setting of NIV and CAB availability, NIV was the most commonly chosen drug, whereas several experts identified situations where CAB would be preferred.
Insights
Expert oncologists
Area of Science:
- Oncology
- Medical treatment strategies
- Renal cell carcinoma research
Background:
- Metastatic clear cell renal cell cancer (mccRCC) treatment varies among experts.
- Investigating second-line systemic therapy after first-line tyrosine kinase inhibitor (TKI) treatment.
- Evaluating the impact of recent nivolumab (NIV) and cabozantinib (CAB) trial data on clinical decisions.
Purpose of the Study:
- To investigate expert approaches to second-line systemic therapy for mccRCC.
- To analyze treatment strategy shifts following the introduction of nivolumab and cabozantinib.
- To understand the consensus on mccRCC treatment post-first-line TKI therapy.
Main Methods:
- Eleven international oncology experts provided treatment strategies for mccRCC.
- Strategies were analyzed for current use and future use after nivolumab and cabozantinib approval.
- An objective consensus approach was employed to analyze treatment decision trees.
Main Results:
- Current second-line options include everolimus (EVE), axitinib (AXI), nivolumab (NIV), and TKI switch (sTKI).
- Future treatment is expected to favor nivolumab (NIV) and cabozantinib (CAB).
- Key decision criteria include duration of response, TKI tolerance, and composite factors (zugzwang).
Conclusions:
- Second-line mccRCC treatment recommendations show less heterogeneity than first-line.
- Everolimus, axitinib, nivolumab, and TKI switch are current options post-first-line TKI.
- Nivolumab is the preferred future agent, with cabozantinib indicated for specific situations.
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