Dr. Figlin on TKI Therapy Options in Renal Cell Carcinoma

Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology and associate director of academic program development in the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, discusses tyrosine kinase inhibitors (TKIs) that he uses to treat patients with renal cell carcinoma (RCC).

Figlin says he always administers TKIs to his patients with RCC in the frontline setting. When he observes that these therapies are no longer working for the patient, he is faced with the decision of selecting another TKI or switching to a checkpoint inhibitor, like nivolumab (Opdivo). He mainly takes into consideration the patient's quality of life, the time spent on treatment, the side effect profile of the treatment, and the overall outcomes.

Though nivolumab does not produce a significant progression-free survival benefit, Figlin knows from experience that his patients often feel better on nivolumab in comparison with TKIs.

If nivolumab is not an ideal choice for his patients, cabozantinib (Cabometyx) and lenvatinib (Lenvima) plus everolimus (Afinitor) are possible alternative treatments. Figlin uses cabozantinib in select patient populations after reading a recent subgroup analysis, which showed benefits associated with the agent for patients with bone metastases. For these particular patients, he tends to start them with cabozantinib and then use nivolumab in the third-line setting.

Figlin says his integration of lenvatinib/everolimus has yet to enter the second- and third-line settings, but he knows that the combination regimen is still an alternative after treatment with cabozantinib and/or nivolumab have already been tried.