In this episode, we had the honor of hosting Dr. Monty Pal from City of Hope, a renowned leader, educator, clinician, and mentor in the field of GU malignancies. The discussion primarily focused on the evolving landscape of treatment options for localized and metastatic renal cell cancer.
Localized Disease: The approval of adjuvant pembrolizumab in 2021 based on DFS and overall survival data has significantly impacted the treatment approach for high-risk patients. Dr. Monty Pal emphasized the superiority of pembrolizumab over sunitinib due to its efficacy and tolerability.
Metastatic Space: The conversation delved into the role of surgery in the era of modern therapies, highlighting the importance of systemic therapy as the primary focus. Various treatment options, including TKI-IO combinations and doublet regimens, were discussed based on risk stratification and disease burden.
Second-Line Treatment: Dr. Monty Pal provided insights into second-line treatment options, emphasizing the use of cabozantinib and everolimus-lenvatinib for robust patients requiring a quick response. The discussion also touched on newer agents like belzutifan and tevosinib, highlighting their efficacy and side effect profiles.
Clinical Pearls: Managing side effects of TKIs and immune checkpoint inhibitors was emphasized, with a focus on recognizing and addressing overlapping toxicities. The importance of individualized treatment based on patient characteristics and response rates was underscored throughout the episode.
Future Directions: Dr. Monty Pal highlighted ongoing clinical trials for non-clear cell histology and the importance of staying updated on evolving treatment strategies in renal cell cancer.
Overall, the episode provided a comprehensive overview of the current standard of care practices in renal cell cancer, offering valuable insights for clinicians and researchers in the field.
