What would be the treatment options for metastatic clear cell carcinoma of kidney who develops recurrent thrombosis despite therapeutic anticoagulant on cabozantinib in second line treatment after failing immunotherapy?

Any TKI will potentially increase the risk of thrombosis, so this is a bit of a challenge for the patient. However, cabozantinib, based on personal experience, is more likely to cause this complication and other TKIs may be better in this regard. If you need to completely avoid TKIs, everolimus monotherapy can be considered but efficacy is quite modest. An alternative next step for this patient may be to try the combination of lenvatinib plus everolimus. Personal experience with this combination...

While thrombosis/thromboembolic events are considered a class effect amongst several VEGF/TKIs, and venous and/or arterial thromboembolic events have been seen in 2-5% of patients with most agents, there may be individual differences in pro-thrombotic effects of these agents. In view of recurrent thrombosis with cabozantinib, it's crucial to ensure compliance and appropriate dosing of the anticoagulants used. Consideration of an alternate TKI is reasonable depending on the severity of thromboemb...