The Role of Molecular Profiling in Optimizing Treatment Decisions for RCC

In the past, treatment decisions have been made based on the location and type of the tumor. Today, genetic profiling is an option to help better guide treatment decisions.

Matthew T. Campbell, MD, MS, spoke about using genetic profiling, and how it’s typically not used after first-line therapy. Genetic profiling is specifically useful for those with advanced renal cell carcinoma (RCC) because of the identification of negative prognostic markers linking to a preferred treatment option.

Campbell, an associate professor in the Department of Genitourinary Oncology at The University of Texas MD Anderson Cancer Center, also highlighted taking into consideration a patient’s quality of life (QOL). He noted that when choosing a treatment option, he considers what kind of QOL would like, and combined with their cancer creates a treatment plan.

Transcript:

In some patients, we will use molecular profiling. As of today, outside of World Health Organization [WHO] classifiers, it doesn’t have a role in terms of us picking frontline therapy. We know that patients with BAP1 mutations have a negative prognostic marker, but it’s not predictive, so what do we use in pathology? We use sarcomatoid dedifferentiation, and if patients have this on their pathology, we will often select nivolumab plus ipilimumab [as a treatment] because response rates are approximately 60%, and complete response rates are approximately 20%. We know that those patients are less responsive to TKI-based treatment.

QOL is hugely important for patients, and this is something that I go to great length in discussing. Nivolumab and ipilimumab have improved QOL compared with sunitinib [Sutent], as did cabozantinib [Cabometyx] plus nivolumab vs sunitinib. This is important. With axitinib [Inlyta] plus pembrolizumab and lenvatinib [Lenvima] plus pembrolizumab, QOL was about the same as sunitinib, which was not great. When we have this [decision-making] conversation, [QOL] is a big part of it. Part of it’s because the cabozantinib dose is lower and tends to be a bit of an easier start for patients, especially those who are frail.