What is your preferred first-line therapy for patients with newly diagnosed intermediate- or poor-risk metastatic clear cell RCC?

For intermediate and poor risk advanced clear cell renal cell carcinoma, combination therapy is the standard of care with 4 different regimens showing an improvement in overall survival vs sunitinib: nivolumab/ipilimumab, pembrolizumab/axitinib, cabozantinib/nivolumab, and pembrolizumab/lenvatinib. ...

The landscape for mRCC continues to change with approvals of several IO/TKI combos. I tend to use IO/TKI in the int/poor risk population with a higher ORR and PFS than ipi/nivo and a robust OS HR. The greater tumor shrinkage may be an advantage if, for example, poor risk patients have disease-relate...

If the patient is fit for immunotherapy, I try to give ipilimumab-nivolumab if possible, for the higher rate of complete responses. If the patient needs more of an immediate tumor response, I will choose one of the VEGF-IO combinations. I'm always thinking about how to optimize the number of treatme...

Can we be very confident that anti-VEGFR TKI + IO is better than TKI followed by IO upon progression?

In the relevant trials, only a minority of patients in the control arm have gotten IO upon progression on sunitinib.