Drs. Pedro Barata, Brad McGregor, Neil Shah, and Michael Serzan emphasize that in advanced RCC, treatment decisions should prioritize the best option in the moment, rather than holding therapies in reserve for later lines. They highlight that while multiple second-line options exist, including VEGF-TKIs and newer combinations, there is no guarantee patients will reach those lines. This reinforces the importance of maximizing upfront efficacy. In the refractory setting, the discussion shifts toward balancing disease control with toxicity and quality of life, with a general preference for starting at full dose and adjusting based on tolerability and clinician familiarity with each regimen.
Contributors:
Dr. Pedro Barata is a medical oncologist in Cleveland, Ohio and is affiliated with University Hospitals Cleveland Medical Center.
Dr. Bradley McGregor is a medical oncologist at Dana-Farber in Boston.
Dr. Neil Shah is a medical oncologist at Memorial Sloan Kettering Cancer Center.
Dr. Michael Serzan is a medical oncologist at Dana-Farber in Boston.
