Dr. Figlin on Sequencing mTOR Inhibitors and TKIs in RCC

Robert Figlin, MD, FACP, Professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, Cedars-Sinai Medical Center, discusses the sequencing of mTOR inhibitors and tyrosine kinase inhibitors (TKI) in renal cell carcinoma.

Figlin points out that in previously-untreated patients a vascular endothelial growth factor receptor (VEGFR) TKI is the treatment of choice for many physicians. There is a small number of patients that receive high-dose IL-2 or temsirolimus based on prognosis.

When determining the appropriate sequencing of agents and the opportunity arises to treat with an mTOR inhibitor (such as everolimus) or another TKI (such as axitinib), Figlin says, it is important for a physician to consider a patient's sensitivity to a pathway inhibitor.

In his practice, Figlin says he keeps a patient on a VEGF TKI in the second-line setting if their initial response to a TKI is outstanding. If the response has been modest and there is an appearance of new disease or rapid progression, Figlin considers the use of an mTOR inhibitor. Figlin's strategy is to tailor second-line treatment based on first-line response and continue this into the third line.

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