Dr Garmezy on Factors Influencing Treatment Selection in Variant RCC

Benjamin Garmezy, MD, medical oncologist assistant director, Genitourinary Research, Sarah Cannon Research Institute, Tennessee Oncology, discusses key factors influencing treatment selection for patients with variant renal cell carcinoma (RCC).

When navigating treatment options in the variant kidney cancer space, emerging data and clinical experience should be used to inform decisions due to limited evidence supporting specific regimens in these subtypes, Garmezy begins.

For papillary RCC, early-phase data suggest potential efficacy with cabozantinib (Cabometyx) in combination with nivolumab (Opdivo), although its applicability in other variant diseases remains uncertain, Garmezy states. Additionally, pembrolizumab (Keytruda) combined with lenvatinib (Lenvima) has demonstrated effectiveness across multiple variants, including papillary RCC, with encouraging response rates observed in clinical trials, he notes.

In a small sample of patients with chromophobe RCC, response rates with lenvatinib plus everolimus (Afinitor) were 28%, Garmezy reports, adding that these findings challenge earlier data on lenvatinib plus everolimus for chromophobe disease. Pembrolizumab with lenvatinib has also shown preliminary activity in chromophobe disease, highlighting its potential utility across different renal cancer variants, Garmezy says.

Given the evolving landscape of variant-specific treatments, the choice of therapy often depends on available data and patient-specific factors, Garmezy continues. For papillary RCC, options such as pembrolizumab plus lenvatinib, cabozantinib monotherapy, or cabozantinib combined with nivolumab are reasonable options, he summarizes. In contrast, lenvatinib plus everolimus or pembrolizumab and lenvatinib may be suitable treatment choices in chromophobe RCC, Garmezy states.

For other variant RCC subtypes where data are limited, a cautious approach is prudent, he emphasizes. Until more robust evidence becomes available, pembrolizumab and lenvatinib remains Garmezy's preferred option.

This approach to treatment selection underscores the complexity of tailoring therapies to specific renal cancer subtypes and highlights the importance of ongoing research to expand treatment options and improve outcomes for patients with variant forms of kidney cancer, Garmezy concludes.