Oncology Brothers: Practice-Changing Cancer Discussions Challenging Cases in Second Line & Beyond Renal Cell Carcinoma (RCC) - Dr. David Braun
Nov 30, 2025
Dr. David Braun, a GU medical oncologist from Yale University, explores the complexities of second-line treatments for renal cell carcinoma. He delves into the different TKI options like cabozantinib and tivozanib, discussing their potency and side effects. The importance of assessing disease progression and biology is highlighted. Additionally, he reviews the risks associated with belzutifan and the management of common TKI-related adverse effects. The conversation emphasizes patient-centered care and decision-making in oncology.
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First-Line Is Now IO + TKI
- The current first-line standard for metastatic RCC is IO+TKI or dual checkpoint inhibitors, not single-agent TKIs.
- After progression, second-line options are limited and largely TKI-based, with evolving evidence for sequencing.
Know The Second-Line Options
- Second-line choices include axitinib, cabozantinib, lenvatinib+everolimus, tivozanib, and belzutifan.
- Belzutifan requires prior IO and prior TKI per trials, so timing matters for eligibility.
Pick Therapy By Progression Trajectory
- Assess the pattern and speed of progression when choosing next therapy.
- Use more aggressive TKIs for rapidly progressing disease and gentler options for slow progression.