In a patient with de novo metastatic RCC s/p Ipi/Nivo with partial response (persistent radiographic disease) 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 decision to add TKI? Would site of persistent metastatic disease (e.g. lung vs bone vs LN) inform decision?

Answer from: Medical Oncologist at Community Practice

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. Supportive of well-designed trials to explore these questions.

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

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