Second-line treatment for metastatic clear cell renal cell cancer: experts' consensus algorithms.
BACKGROUND
Second-line systemic treatment options for metastatic clear cell renal cell cancer (mccRCC) are diverse and treatment strategies are variable among experts. Our aim was to investigate the approach for the second-line treatment after first-line therapy with a tyrosine kinase inhibitor (TKI). Recently two phase III trials have demonstrated a potential role for nivolumab (NIV) and cabozantinib (CAB) in this setting. We aimed to estimate the impact of these trials on clinical decision making.


MATERIALS AND METHODS
Eleven international experts were asked to provide their treatment strategies for second-line systemic therapy for mccRCC in the current setting and once NIV and CAB will be approved and available. The treatment strategies were analyzed with the objective consensus approach.


RESULTS
The analysis of the decision trees revealed everolimus (EVE), axitinib (AXI), NIV and TKI switch (sTKI) as therapeutic options after first-line TKI therapy in the current situation and mostly NIV and CAB in the future setting. The most commonly used criteria for treatment decisions were duration of response, TKI tolerance and zugzwang a composite of several related criteria.


CONCLUSION
In contrast to the first-line setting, recommendations for second-line systemic treatment of mccRCC among experts were not as heterogeneous. The agents mostly used after disease progression on a first-line TKI included: EVE, AXI, NIV and sTKI. In the future setting of NIV and CAB availability, NIV was the most commonly chosen drug, whereas several experts identified situations where CAB would be preferred.
['Rothermundt|C|C|', 'von Rappard|J|J|', 'Eisen|T|T|', 'Escudier|B|B|', 'Grünwald|V|V|', 'Larkin|J|J|', 'McDermott|D|D|', 'Oldenburg|J|J|', 'Porta|C|C|', 'Rini|B|B|', 'Schmidinger|M|M|', 'Sternberg|C N|CN|', 'Putora|P M|PM|']
D000465:Algorithms D000813:Anilides D000911:Antibodies, Monoclonal D000970:Antineoplastic Agents D000077784:Axitinib D002292:Carcinoma, Renal Cell D032921:Consensus D003661:Decision Support Techniques D003663:Decision Trees D000068338:Everolimus D006801:Humans D007093:Imidazoles D007191:Indazoles D007680:Kidney Neoplasms D000077594:Nivolumab D047428:Protein Kinase Inhibitors D011725:Pyridines D017211:Treatment Failure
Renal cell cancer Consensus Algorithm Diagnostic nodes