Area of Science:

• Oncology
• Medical treatment of cancer
• Renal cell carcinoma research

Background:

• Advanced or metastatic renal cell cancer (RCC) treatment has seen significant advancements.
• Patients progressing on antiangiogenic therapy (VEGFR TKIs like sunitinib or pazopanib) require effective second-line options.

Purpose of the Study:

• To review efficacy, safety, and quality of life data from pivotal clinical studies in second-line advanced/metastatic RCC.
• To assist clinicians in selecting the most appropriate second-line treatment for RCC patients.
• To inform sequencing strategies for maximizing patient benefit from available therapies.

Main Methods:

• Review of main pivotal clinical studies for advanced or metastatic RCC in the second-line setting.
• Analysis of efficacy, safety, and quality of life outcomes for various treatment options.
• Comparison of treatments including axitinib, everolimus, cabozantinib, and nivolumab.

Main Results:

• Axitinib and everolimus were initially recommended for second-line treatment.
• Cabozantinib (VEGFR, MET, AXL inhibitor) and nivolumab (anti-PD-1 inhibitor) are now standard of care.
• Lenvatinib combined with everolimus shows promise but has limited availability.

Conclusions:

• Selecting the optimal second-line treatment for advanced/metastatic RCC is complex due to multiple effective options.
• Clinicians need comprehensive data on efficacy, safety, and quality of life to guide treatment choices.
• Defining sequential treatment strategies is crucial for patients to receive all therapies that improve overall survival.