Factors Affecting Treatment Choices for Variant RCC

Variant renal cell carcinoma (RCC) presents unique challenges when it comes to treatment selection, according to Benjamin Garmezy, MD, a medical oncologist assistant director at the Genitourinary Research department of the Sarah Cannon Research Institute, Tennessee Oncology.

Garmezy emphasizes the importance of using emerging data and clinical experience to guide treatment decisions in the absence of specific evidence supporting regimens for these subtypes. In the case of papillary RCC, early-phase data suggests the potential efficacy of cabozantinib in combination with nivolumab, although its effectiveness in other variant diseases remains uncertain. Similarly, pembrolizumab combined with lenvatinib has shown promise across multiple variants, including papillary RCC.

For patients with chromophobe RCC, Garmezy highlights that lenvatinib plus everolimus has demonstrated a 28% response rate, challenging previous data on this regimen. Additionally, pembrolizumab with lenvatinib has shown preliminary activity in chromophobe disease, indicating its potential use across different renal cancer variants.

The evolving landscape of variant-specific treatments underscores the importance of considering available data and patient-specific factors when selecting therapy. Garmezy suggests options such as pembrolizumab plus lenvatinib, cabozantinib monotherapy, or cabozantinib combined with nivolumab for papillary RCC, while lenvatinib plus everolimus or pembrolizumab and lenvatinib are suitable choices for chromophobe RCC.

In cases where data is limited, Garmezy advises a cautious approach and recommends pembrolizumab with lenvatinib as the preferred option until more robust evidence becomes available. Ultimately, tailoring therapies to specific renal cancer subtypes and ongoing research play a crucial role in expanding treatment options and improving outcomes for patients with variant forms of kidney cancer.