Clinical Experience in Treating nccRCC (Patient Case 2)
Panelists discuss the complex management of papillary renal cell carcinoma (RCC) after first-line progression, focusing on balancing effective second-line therapies like lenvatinib plus pembrolizumab with quality of life, the role of multidisciplinary care and surgery, the importance of close monitoring, and the critical need for clinical trial enrollment and genomic profiling to guide personalized treatment.
EP: 1.Overview of the First-Line ccRCC Treatment Landscape
EP: 2.Treatment Management Strategies
EP: 3.Overview of the Second-Line ccRCC Treatment Landscape
EP: 4.Clinical Experience in Treating ccRCC (Patient Case 1)
EP: 5.Overview of the First-Line nccRCC Treatment Landscape
EP: 6.Overview of the Second-Line nccRCC Treatment Landscape
EP: 7.Clinical Experience in Treating nccRCC (Patient Case 2)
EP: 8.Adverse Event Management Strategies in Renal Cell Carcinoma
A 52-year-old man diagnosed with papillary RCC 1 year ago initially responded partially to first-line cabozantinib, with stable disease for 8 months. Recent imaging shows progression with increased size and number of lymph nodes, a new left adrenal lesion, and growth of the primary tumor. The patient’s labs are largely unremarkable except for mild chronic kidney disease. He is concerned about balancing treatment effectiveness with quality of life as he continues to work and support his family. Managing toxicity while maximizing long-term disease control is a primary goal in selecting second-line therapy.
In approaching treatment, aggressive up-front strategies such as combining lenvatinib with pembrolizumab are considered, especially because the patient has not previously received immunotherapy. Close monitoring and dose adjustments are key to managing adverse effects while maintaining treatment intensity. For patients with limited lymph node involvement, systemic therapy followed by surgical resection is an appealing option, aiming to reduce disease burden and improve tolerability. Scans are typically done every 3 months using CT and occasional bone or brain imaging to monitor progression and adverse effects. Given the limited options in non–clear cell RCC (nccRCC) beyond the second line, multidisciplinary care and careful sequencing are critical.
Clinical trial participation is strongly encouraged, especially at centers with active phase 1 programs. Although emerging therapies like hypoxia-inducible factor inhibitors show limited promise in nccRCC, novel approaches including chimeric antigen receptor (CAR) T-cell and CAR natural killer cell therapies might be explored. Genomic profiling is prioritized in nccRCC cases to identify actionable mutations that may guide enrollment in experimental studies. For clear cell RCC, genomic testing is often reserved for later lines when trial options become relevant. Overall, tailoring treatment based on disease biology, patient goals, and available clinical trials is essential to optimize outcomes in this challenging setting.
