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...

Given randomized trials showing improved efficacy of both nivo/ipi and cabozantinib to sunitinib in intermediate/poor risk patients. Both options appear to be reasonable choices in the 1st line setting. The choice between the two regimens should be based on patient individualized decision including ...

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.