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In a patient with de novo metastatic RCC s/p Ipi/Nivo with partial response and residual viable RCC on cytoreductive nephrectomy, would you add cabozantinib or other TKI prior to disease progression?

Would the lack of pathologic complete response on nephrectomy inform the decision to add TKI? Would the site of persistent metastatic disease (e.g., lung vs bone vs LN) inform the decision?
3 Answers
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Medical Oncology · The University of Texas, M.D. Anderson Cancer Center
Answered on

No, committing a patient to the substantial (and frequently occurring) adverse events of anti-VEGF TKIs like cabozantinib would require convincing evidence of clinically meaningful benefit, which is currently lacking in this setting. I am supportive of well-designed trials to explore these questions...

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Medical Oncology · The University of Texas Health Science Center at San Antonio
Answered on · Updated on

Cytoreductive nephrectomy in asymptomatic patients is a controversial topic. There is some data suggesting clinical benefit to patients, but prospective data in the present checkpoint inhibitor era are needed. Fortunately, there are ongoing prospective clinical trials to provide this much-needed dat...

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Medical Oncology · Vanderbilt-Ingram Cancer Center
Answered on

The short answer is no. There is emerging data about the role of deferred cytoreductive nephrectomy in patients who receive initial immune-based therapy with a good response. There are several unanswered questions in this setting, such as the timing of surgery and the need for systemic therapy after...

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