Dr Hall on Unmet Needs in Later-Line RCC

"Right now, most of our treatments fall into a few baskets, so sometimes we’re left with uncomfortable decisions about using drugs that may interact with patient comorbidities. [Patients need] more options and [drugs with] different mechanisms, with the hope that perhaps we can find better fits for individual patients in the second- and third-line settings."

Evan T. Hall, MD, MPhil, a physician and assistant professor in the Clinical Research Division at the Fred Hutchinson Cancer Center; as well as an assistant professor at the University of Washington School of Medicine, highlighted several key unmet needs for patients with later-line renal cell carcinoma (RCC) that may be addressed by future research.

One major gap is the need for a second opportunity at achieving long-term disease control, Hall began. According to Hall, enduring remission and the potential for a treatment-free interval appear to be phenomena associated primarily with immunotherapy. He explained that although TKIs can suppress disease progression during active treatment, relapse typically occurs upon discontinuation. Thus, developing a second-line or even third-line therapy with immunomodulatory potential to induce prolonged remission could represent a significant advancement, Hall noted.

Hall also emphasized the importance of expanding therapeutic targets with differentiated toxicity profiles. Many patients with RCC are older and often present with comorbidities, such as coronary artery disease, heart failure, prior stroke, or diabetes. Hall observed that current later-line treatment options tend to cluster within a limited number of drug classes, many of which carry adverse effect profiles that may exacerbate underlying conditions. He stated that broader mechanistic diversity in available therapies could help oncologists better tailor treatment to individual patient needs, thereby improving tolerability and reducing the risk of treatment-related complications.

Ultimately, Hall concluded that the later-line RCC treatment paradigm wouldbenefit from therapies with novel mechanisms and improved safety profiles, particularly those that offer the potential for durable responses and allow for better personalization based on comorbid conditions.