Moderator Robert A. Figlin, MD, introduces a panel discussion focuses on therapeutic advances in the treatment of renal cell cancer (RCC), with an emphasis on key case studies in community oncology practice. The discussion includes expert analysis from Janice P. Dutcher, MD, Robert A. Figlin, MD, Charles A. Henderson, MD, Daniel Heng, MD, MPH, and Brian I. Rini, MD.

An accurate assessment of clinical features should be conducted prior to determining an optimal frontline therapy, Henderson notes. If the patient has an intact primary tumor, cytoreductive surgery may be an option. Furthermore, if CNS metastases are present, neurosurgery or radiation is a potential option. Moreover, in young healthy patients, interleuken-2 could even be an option, Henderson believes.

In general, given his experience with the COMPARZ and PISCES studies that compared frontline pazopanib to sunitinib, Henderson generally favors treatment with pazopanib in the frontline setting. Based on these studies, pazopanib appears to be better tolerated with similar efficacy, he believes.

In some situations the patient may not require frontline treatment at all, Brian I. Rini, MD, suggests. A study was recently presented at the 2014 ASCO Annual Meeting that examined observation prior to the initiation of systemic therapy in patients with metastatic RCC. In total, 52 patients with ECOG performance status 0 and a median baseline tumor burden of 3.2 cm were enrolled in the trial. Patients with a tumor burden ≤1.5 cm could safely be observed for 31.6 months prior to the initiation of systemic therapy compared with 13.8 months for patients with >1.5 cm disease.

Further analyses from this study have yet to be performed, Rini cautions. At this point there is not enough data to support a subanalysis based on metastatic site or disease stage. These results could translate to patients with non-clear cell histology, Rini believes, although most patients on the trial had clear cell histology.