Dr Matrana on Factors Influencing Upfront Treatment Approaches for RCC

"[Considering both] patient characteristics and disease characteristics [is valuable], and then you try to personalize [treatment decisions] based on those [factors]."

Marc R. Matrana, MD, a medical oncologist and director of Genitourinary Medical Oncology Research at Ochsner MD Anderson Cancer Center, as well as a professor of internal medicine at The University of Queensland Medical School – Ochsner Health, outlined factors informing treatment decision-making in the frontline setting for patients with renal cell carcinoma (RCC).

Treatment selection in advanced RCC requires careful consideration of both patient-specific and disease-related characteristics to optimize efficacy and simultaneously minimize the potential for developing adverse effects, Matrana began. The initial step involves assessment of comorbid conditions that may affect the safety or feasibility of certain systemic therapies, he shared. For example, the presence of liver dysfunction or pre-existing autoimmune disease may necessitate a more cautious RCC treatment approach, Matrana explained. Patients with a history of solid organ transplantation or uncontrolled autoimmune disorders may not be ideal candidates for immune checkpoint inhibitors due to the risk of allograft rejection or immune-mediated toxicity, he added. Similarly, in patients with significant hepatic impairment or uncontrolled hypertension, VEGF-targeted TKIs may pose additional risks, such as hepatotoxicity or increased blood pressure, Matrana noted.

The second component of treatment decision-making includes an evaluation of tumor characteristics, he continued. The presence of bone metastases may favor the use of cabozantinib (Cabometyx), a TKI with demonstrated efficacy in skeletal disease, Matrana stated. Central nervous system (CNS) involvement is another critical factor; although data in this setting remain limited, treatment selection may need to prioritize agents with CNS activity or accessibility, he said, adding that histologic RCC subtype is also relevant, as most clinical trial data are derived from patients with clear cell RCC. However, some TKIs have shown activity in non–clear cell subtypes, which may guide off-label use in these populations, Matrana noted.

By integrating both patient and tumor features, oncologists can tailor treatment strategies to individual patient profiles, Matrana reiterates. Ultimately, the goal is to maximize clinical benefit and minimize harm through a personalized treatment framework grounded in a nuanced understanding of comorbidities and tumor biology, he concluded.