Dr. Alva on the Shift Toward Combination Therapy in mRCC

Ajjai Shivaram Alva, MBBS, discusses the shift toward combination therapy versus monotherapy in metastatic renal cell carcinoma.

Ajjai Shivaram Alva, MBBS, an associate professor at the University of Michigan, discusses the shift toward combination therapy in metastatic renal cell carcinoma (mRCC).

The role of combination therapy has grown significantly in mRCC, explains Alva. As such, the utility of monotherapy in this space is diminishing.

By combining TKIs and checkpoint inhibitors, patients get the benefit of dual VEGF and PD-1/PD-L1 blockade, says Alva. Historically, both classes of agents have demonstrated activity in mRCC.

Going forward, the question of what treatment to give patients who progress on a TKI/immunotherapy combination needs to be answered, Alva says.

Novel classes of agents including metabolic inhibitors, glutamine inhibitors, arginase inhibitors, and HIF-1α inhibitors may have a role in the second-line setting, concludes Alva.

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