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Subsequent Line Systemic Treatment Options for Advanced Renal Cell Carcinoma

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Integrating Multidisciplinary Treatment for Advanced Renal Cell Carcinoma

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Abstract

The therapeutic landscape of front-line metastatic renal cell carcinoma (mRCC) has shifted dramatically, and combination therapies are now a standard of care. Subsequently, the data for treatment options in second line and beyond has evolved. Recent phase 2/3 trials and retrospective analyses provide insights into treatment in the post-immunotherapy setting. It is crucial to compare the different types of treatments available to guide safe and effective therapeutic strategies as we await more phase 3 data exploring novel combinations and drugs in this space.

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Abbreviations

ADC:

Antibody-drug conjugate

AE:

Adverse event

ccRCC:

Clear cell RCC

CR:

Complete response

ENPP3:

Ectonucleotide phosphodiesterase-pyrophosphatase 3

FRACTION-RCC:

Fast Real-Time Assessment of Combination Therapies in Immuno-Oncology

HIF:

Hypoxia Inducible Factor

ICB:

Immune Checkpoint Blockade

IL-2:

Interleukin 2

mRCC:

Metastatic renal cell carcinoma

mTOR:

Mammalian target of rapamycin

ORR:

Objective response rate

OS:

Overall survival

PD:

Progressive disease

PFS:

Progression-free survival

Tela:

Telaglenastat

TIM1:

T-cell immunoglobulin and mucin domain 1

TKI:

Tyrosine kinase inhibitor

VEGFR:

Vascular endothelial growth factor receptor

VHL:

Von-Hippel Lindau

References

  1. Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356(2):115–24. https://doi.org/10.1056/NEJMoa065044.

    Article  CAS  PubMed  Google Scholar 

  2. Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007;356(2):125–34. https://doi.org/10.1056/NEJMoa060655.

    Article  CAS  PubMed  Google Scholar 

  3. Motzer RJ, Escudier B, Tomczak P, Hutson TE, Michaelson MD, Negrier S, et al. Axitinib versus sorafenib as second-line treatment for advanced renal cell carcinoma: overall survival analysis and updated results from a randomised phase 3 trial. Lancet Oncol. 2013;14(6):552–62.

    Article  CAS  PubMed  Google Scholar 

  4. Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S, et al. Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer. 2010;116(18):4256–65.

    Article  CAS  PubMed  Google Scholar 

  5. Choueiri TK, Escudier B, Powles T, Tannir NM, Mainwaring PN, Rini BI, et al. Cabozantinib versus everolimus in advanced renal cell carcinoma (METEOR): final results from a randomised, open-label, phase 3 trial. Lancet Oncol. 2016;17(7):917–27.

    Article  CAS  PubMed  Google Scholar 

  6. Motzer RJ, Hutson TE, Glen H, Michaelson MD, Molina A, Eisen T, et al. Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial. Lancet Oncol. 2015;16(15):1473–82. https://doi.org/10.1016/S1470-2045(15)00290-9.

    Article  CAS  PubMed  Google Scholar 

  7. Motzer RJ, Escudier B, McDermott DF, George S, Hammers HJ, Srinivas S, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373(19):1803–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Motzer RJ, Tannir NM, McDermott DF, Arén Frontera O, Melichar B, Choueiri TK, et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med. 2018;378(14):1277–90. https://doi.org/10.1056/NEJMoa1712126.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Rini BI, Plimack ER, Stus V, Gafanov R, Hawkins R, Nosov D, et al. Pembrolizumab (pembro) plus axitinib (axi) versus sunitinib as first-line therapy for metastatic renal cell carcinoma (mRCC): outcomes in the combined IMDC intermediate/poor risk and sarcomatoid subgroups of the phase 3 KEYNOTE-426 study. J Clin Oncol. 2019;37(15 Suppl):4500. https://doi.org/10.1200/JCO.2019.37.15_suppl.4500.

    Article  Google Scholar 

  10. Motzer RJ, Penkov K, Haanen J, Rini B, Albiges L, Campbell MT, et al. Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019;380(12):1103–15. https://doi.org/10.1056/NEJMoa1816047.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Choueiri TK, Powles T, Burotto M, Escudier B, Bourlon MT, Zurawski B, et al. Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2021;384(9):829–41. https://doi.org/10.1056/NEJMoa2026982.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Motzer R, Alekseev B, Rha S-Y, Porta C, Eto M, Powles T, et al. Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. N Engl J Med. 2021;384(14):1289–300. https://doi.org/10.1056/NEJMoa2035716.

    Article  CAS  PubMed  Google Scholar 

  13. Schmidt AL, Siefker-Radtke A, McConkey D, McGregor B. Renal cell and urothelial carcinoma: biomarkers for new treatments. Am Soc Clin Oncol Educ B. 2020;40:e197–206. https://doi.org/10.1200/EDBK_279905.

    Article  Google Scholar 

  14. Albiges L, Fay AP, Xie W, Krajewski K, McDermott DF, Heng DYC, et al. Efficacy of targeted therapies after PD-1/PD-L1 blockade in metastatic renal cell carcinoma. Eur J Cancer. 2015;51(17):2580–6.

    Article  CAS  PubMed  Google Scholar 

  15. Cao X, Tang D, Ratto B, Poole A, Ravichandran S, Jin L, et al. Real-world clinical outcomes of pazopanib immediately after discontinuation of immunotherapy for advanced renal cell carcinoma. Clin Genitourin Cancer. 2020;18(1):e37–45. https://doi.org/10.1016/j.clgc.2019.10.010.

    Article  PubMed  Google Scholar 

  16. Shah AY, Kotecha RR, Lemke EA, Chandramohan A, Chaim JL, Msaouel P, et al. Outcomes of patients with metastatic clear-cell renal cell carcinoma treated with second-line VEGFR-TKI after first-line immune checkpoint inhibitors. Eur J Cancer. 2019;114:67–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Nadal R, Amin A, Geynisman DM, Voss MH, Weinstock M, Doyle J, et al. Safety and clinical activity of vascular endothelial growth factor receptor (VEGFR)-tyrosine kinase inhibitors after programmed cell death 1 inhibitor treatment in patients with metastatic clear cell renal cell carcinoma. Ann Oncol. 2016;27(7):1304–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Auvray M, Auclin E, Barthelemy P, Bono P, Kellokumpu-Lehtinen P, Gross-Goupil M, et al. Second-line targeted therapies after nivolumab-ipilimumab failure in metastatic renal cell carcinoma. Eur J Cancer. 2019;108:33–40. https://www.sciencedirect.com/science/article/pii/S0959804918315399.

    Article  CAS  PubMed  Google Scholar 

  19. Graham J, Shah AY, Wells JC, McKay RR, Vaishampayan U, Hansen A, et al. Outcomes of patients with metastatic renal cell carcinoma treated with targeted therapy after immuno-oncology checkpoint inhibitors. Eur Urol Oncol. 2021;4(1):102–11.

    Article  PubMed  Google Scholar 

  20. Dudani S, Graham J, Wells JC, Bakouny Z, Pal SK, Dizman N, et al. First-line immuno-oncology combination therapies in metastatic renal-cell carcinoma: results from the International Metastatic Renal-cell Carcinoma Database Consortium. Eur Urol. 2019;76(6):861–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Stukalin I, Dudani S, Wells C, Gan CL, Pal SK, Dizman N, et al. Second-line VEGF TKI after IO combination therapy: results from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). J Clin Oncol. 2020;38(6 Suppl):684. https://doi.org/10.1200/JCO.2020.38.6_suppl.684.

    Article  Google Scholar 

  22. Ged Y, Gupta R, Duzgol C, Knezevic A, Shapnik N, Kotecha R, et al. Systemic therapy for advanced clear cell renal cell carcinoma after discontinuation of immune-oncology and VEGF targeted therapy combinations. BMC Urol. 2020;20(1):84. https://doi.org/10.1186/s12894-020-00647-w.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. McGregor BA, Lalani A-KA, Xie W, Steinharter JA, Bakouny ZE, Martini DJ, et al. Activity of cabozantinib after immune checkpoint blockade in metastatic clear-cell renal cell carcinoma. Eur J Cancer. 2020;135:203–10.

    Article  CAS  PubMed  Google Scholar 

  24. Iacovelli R, Ciccarese C, Facchini G, Milella M, Urbano F, Basso U, et al. Cabozantinib after a previous immune checkpoint inhibitor in metastatic renal cell carcinoma: a retrospective multi-institutional analysis. Target Oncol. 2020;15(4):495–501.

    Article  PubMed  Google Scholar 

  25. Wiele AJ, Bathala TK, Hahn AW, Xiao L, Duran M, Ross JA, et al. Lenvatinib with or without everolimus in patients with metastatic renal cell carcinoma after immune checkpoint inhibitors and vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapies. Oncologist. 2021;26(6):476–82. https://doi.org/10.1002/onco.13770.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Ornstein MC, Pal SK, Wood LS, Tomer JM, Hobbs BP, Jia XS, et al. Individualised axitinib regimen for patients with metastatic renal cell carcinoma after treatment with checkpoint inhibitors: a multicentre, single-arm, phase 2 study. Lancet Oncol. 2019;20(10):1386–94.

    Article  CAS  PubMed  Google Scholar 

  27. Motzer RJ, Lee C-H, Emamekhoo H, Matrana M, Percent I, Hsieh JJ, et al. LBA54 - ENTRATA: randomized, double-blind, phase II study of telaglenastat (Tela; CB-839) + everolimus (E) vs placebo (Pbo) + E in patients (pts) with advanced/metastatic renal cell carcinoma (mRCC). Ann Oncol. 2019;30:v889–90. https://www.sciencedirect.com/science/article/pii/S0923753419604084.

    Article  Google Scholar 

  28. Emberley E, Pan A, Chen J, Dang R, Gross M, Huang T, et al. The glutaminase inhibitor telaglenastat enhances the antitumor activity of signal transduction inhibitors everolimus and cabozantinib in models of renal cell carcinoma. PLoS One. 2021;16(11):e0259241. https://pubmed.ncbi.nlm.nih.gov/34731180.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Tannir NM, Agarwal N, Porta C, Lawrence NJ, Motzer RJ, Lee RJ, et al. CANTATA: primary analysis of a global, randomized, placebo (Pbo)-controlled, double-blind trial of telaglenastat (CB-839) + cabozantinib versus Pbo + cabozantinib in advanced/metastatic renal cell carcinoma (mRCC) patients (pts) who progressed on immune checkpoint inhibitor (ICI) or anti-angiogenic therapies. J Clin Oncol. 2021;39(15 Suppl):4501. https://doi.org/10.1200/JCO.2021.39.15_suppl.4501.

    Article  Google Scholar 

  30. Rini BI, Pal SK, Escudier BJ, Atkins MB, Hutson TE, Porta C, et al. Tivozanib versus sorafenib in patients with advanced renal cell carcinoma (TIVO-3): a phase 3, multicentre, randomised, controlled, open-label study. Lancet Oncol. 2020;21(1):95–104.

    Article  CAS  PubMed  Google Scholar 

  31. Motzer RJ, Nosov D, Eisen T, Bondarenko I, Lesovoy V, Lipatov O, et al. Tivozanib versus sorafenib as initial targeted therapy for patients with metastatic renal cell carcinoma: results from a phase III trial. J Clin Oncol. 2013;31(30):3791–9. https://doi.org/10.1200/JCO.2012.47.4940.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Martini DJ, Liu Y, Shabto JM, Lewis C, Kline MR, Collins H, et al. Clinical outcomes of advanced stage cancer patients treated with sequential immunotherapy in phase 1 clinical trials. Investig New Drugs. 2019;37(6):1198–206.

    Article  CAS  Google Scholar 

  33. Ravi P, Mantia C, Su C, Sorenson K, Elhag D, Rathi N, et al. Evaluation of the safety and efficacy of immunotherapy rechallenge in patients with renal cell carcinoma. JAMA Oncol. 2020;6(10):1606–10.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gul A, Stewart TF, Mantia CM, Shah NJ, Gatof ES, Long Y, et al. Salvage ipilimumab and nivolumab in patients with metastatic renal cell carcinoma after prior immune checkpoint inhibitors. J Clin Oncol. 2020;38(27):3088–94. https://doi.org/10.1200/JCO.19.03315.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Choueiri TK, Kluger HM, George S, Tykodi SS, Kuzel TM, Perets R, et al. FRACTION-RCC: innovative, high-throughput assessment of nivolumab + ipilimumab for treatment-refractory advanced renal cell carcinoma (aRCC). J Clin Oncol. 2020;38(15 Suppl):5007. https://doi.org/10.1200/JCO.2020.38.15_suppl.5007.

    Article  Google Scholar 

  36. Grimm M-O, Esteban E, Barthélémy P, Schmidinger M, Busch J, Valderrama BP, et al. Efficacy of nivolumab/ipilimumab in patients with initial or late progression with nivolumab: updated analysis of a tailored approach in advanced renal cell carcinoma (TITAN-RCC). J Clin Oncol. 2021;39(15 Suppl):4576. https://doi.org/10.1200/JCO.2021.39.15_suppl.4576.

    Article  Google Scholar 

  37. Atkins MB, Jegede O, Haas NB, McDermott DF, Bilen MA, Drake CG, et al. Phase II study of nivolumab and salvage nivolumab + ipilimumab in treatment-naïve patients (pts) with advanced renal cell carcinoma (RCC) (HCRN GU16-260). J Clin Oncol. 2020;38(15 Suppl):5006. https://doi.org/10.1200/JCO.2020.38.15_suppl.5006.

    Article  Google Scholar 

  38. McKay RR, McGregor BA, Xie W, Braun DA, Wei X, Kyriakopoulos CE, et al. Optimized management of nivolumab and ipilimumab in advanced renal cell carcinoma: a response-based phase II study (OMNIVORE). J Clin Oncol. 2020;38(36):4240–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Taylor MH, Lee C-H, Makker V, Rasco D, Dutcus CE, Wu J, et al. Phase IB/II trial of lenvatinib plus pembrolizumab in patients with advanced renal cell carcinoma, endometrial cancer, and other selected advanced solid tumors. J Clin Oncol. 2020;38(11):1154–63. https://doi.org/10.1200/JCO.19.01598.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Lee J-L, Ziobro M, Suarez C, Langiewitz P, Matveev VB, Wiechno P, et al. First-line pembrolizumab (pembro) monotherapy in advanced non-clear cell renal cell carcinoma (nccRCC): updated follow-up for KEYNOTE-427 cohort B. J Clin Oncol. 2020;38(15 Suppl):5034. https://doi.org/10.1200/JCO.2020.38.15_suppl.5034.

    Article  Google Scholar 

  41. Albiges L, Barthélémy P, Gross-Goupil M, Negrier S, Needle MN, Escudier B. TiNivo: safety and efficacy of tivozanib-nivolumab combination therapy in patients with metastatic renal cell carcinoma. Ann Oncol. 2021;32(1):97–102. https://doi.org/10.1016/j.annonc.2020.09.021.

    Article  CAS  PubMed  Google Scholar 

  42. Pal SK, Albiges L, Suarez Rodriguez C, Liu B, Doss J, Khurana S, et al. CONTACT-03: randomized, open-label phase III study of atezolizumab plus cabozantinib versus cabozantinib monotherapy following progression on/after immune checkpoint inhibitor (ICI) treatment in patients with advanced/metastatic renal cell carcinoma. J Clin Oncol. 2021;39(6 Suppl):TPS370. https://doi.org/10.1200/JCO.2021.39.6_suppl.TPS370.

    Article  Google Scholar 

  43. Zhang T, Ballman KV, Choudhury AD, Chen RC, Watt C, Wen Y, et al. PDIGREE: an adaptive phase III trial of PD-inhibitor nivolumab and ipilimumab (IPI-NIVO) with VEGF TKI cabozantinib (CABO) in metastatic untreated renal cell cancer (Alliance A031704). J Clin Oncol. 2021;39(6 Suppl):TPS366. https://doi.org/10.1200/JCO.2021.39.6_suppl.TPS366.

    Article  Google Scholar 

  44. Braun DA, Bakouny Z, Hirsch L, Flippot R, Van Allen EM, Wu CJ, et al. Beyond conventional immune-checkpoint inhibition—novel immunotherapies for renal cell carcinoma. Nat Rev Clin Oncol. 2021;18(4):199–214. https://doi.org/10.1038/s41571-020-00455-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Ravi P, Bakouny Z, Schmidt A, Choueiri TK. Novel therapeutic approaches and the evolution of drug development in advanced kidney cancer. Cancer J. 2020;26(5):464–70.

    Article  CAS  PubMed  Google Scholar 

  46. Powles T, Rosenberg JE, Sonpavde GP, Loriot Y, Durán I, Lee J-L, et al. Enfortumab vedotin in previously treated advanced urothelial carcinoma. N Engl J Med. 2021;384(12):1125–35. https://doi.org/10.1056/NEJMoa2035807.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. McGregor BA, Gordon M, Flippot R, Agarwal N, George S, Quinn DI, et al. Safety and efficacy of CDX-014, an antibody-drug conjugate directed against T cell immunoglobulin mucin-1 in advanced renal cell carcinoma. Investig New Drugs. 2020;38(6):1807–14.

    Article  CAS  Google Scholar 

  48. Kollmannsberger C, Choueiri TK, Heng DYC, George S, Jie F, Croitoru R, et al. A randomized phase II study of AGS-16C3F versus axitinib in previously treated patients with metastatic renal cell carcinoma. Oncologist. 2021;26(3):182-e361.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Massard C, Soria J-C, Krauss J, Gordon M, Lockhart AC, Rasmussen E, et al. First-in-human study to assess safety, tolerability, pharmacokinetics, and pharmacodynamics of the anti-CD27L antibody-drug conjugate AMG 172 in patients with relapsed/refractory renal cell carcinoma. Cancer Chemother Pharmacol. 2019;83(6):1057–63.

    Article  CAS  PubMed  Google Scholar 

  50. Tannir NM, Forero-Torres A, Ramchandren R, Pal SK, Ansell SM, Infante JR, et al. Phase I dose-escalation study of SGN-75 in patients with CD70-positive relapsed/refractory non-Hodgkin lymphoma or metastatic renal cell carcinoma. Investig New Drugs. 2014;32(6):1246–57.

    Article  CAS  Google Scholar 

  51. https://clinicaltrials.gov/ct2/show/NCT02947152.

  52. Su EW, Lin JY, Kane LP. TIM-1 and TIM-3 proteins in immune regulation. Cytokine. 2008;44(1):9–13. https://pubmed.ncbi.nlm.nih.gov/18706830.

  53. Thompson JA, Motzer RJ, Molina AM, Choueiri TK, Heath EI, Redman BG, et al. Phase I trials of anti-ENPP3 antibody–drug conjugates in advanced refractory renal cell carcinomas. Clin Cancer Res. 2018;24(18):4399–406. http://clincancerres.aacrjournals.org/content/24/18/4399.abstract.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Bialucha CU, Collins SD, Li X, Saxena P, Zhang X, Dürr C, et al. Discovery and optimization of HKT288, a cadherin-6-targeting ADC for the treatment of ovarian and renal cancers. Cancer Discov. 2017;7(9):1030–45.

    Article  CAS  PubMed  Google Scholar 

  55. Voss MH, Gordon MS, Mita M, Rini B, Makker V, Macarulla T, et al. Phase 1 study of mTORC1/2 inhibitor sapanisertib (TAK-228) in advanced solid tumours, with an expansion phase in renal, endometrial or bladder cancer. Br J Cancer. 2020;123(11):1590–8. https://doi.org/10.1038/s41416-020-01041-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. McGregor BA, Adib E, Xie W, Stadler WM, Zakharia Y, Michaelson MD, et al. Biomarker-based phase II study of sapanisertib (TAK-228), an mTORC1/2 inhibitor in patients with refractory metastatic renal cell carcinoma (mRCC). J Clin Oncol. 2021;39(6 Suppl):306. https://doi.org/10.1200/JCO.2021.39.6_suppl.306.

    Article  Google Scholar 

  57. Shen C, Kaelin WGJ. The VHL/HIF axis in clear cell renal carcinoma. Semin Cancer Biol. 2013;23(1):18–25.

    Article  CAS  PubMed  Google Scholar 

  58. Jonasch E, Donskov F, Iliopoulos O, Rathmell WK, Narayan V, Maughan BL, et al. Phase II study of the oral HIF-2α inhibitor MK-6482 for Von Hippel-Lindau disease–associated renal cell carcinoma. J Clin Oncol. 2020;38(15 Suppl):5003. https://doi.org/10.1200/JCO.2020.38.15_suppl.5003.

    Article  Google Scholar 

  59. Choueiri TK, Bauer TM, Papadopoulos KP, Plimack ER, Merchan JR, McDermott DF, et al. Inhibition of hypoxia-inducible factor-2α in renal cell carcinoma with belzutifan: a phase 1 trial and biomarker analysis. Nat Med. 2021;27(5):802–5. https://doi.org/10.1038/s41591-021-01324-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Choueiri TK, Albiges L, Fan L, Perini RF, Zojwalla NJ, Powles T, et al. Phase III study of the hypoxia-inducible factor 2α (HIF-2α) inhibitor MK-6482 versus everolimus in previously treated patients with advanced clear cell renal cell carcinoma (ccRCC). J Clin Oncol. 2020;38(15 Suppl):TPS5094. https://doi.org/10.1200/JCO.2020.38.15_suppl.TPS5094.

    Article  Google Scholar 

  61. https://clinicaltrials.gov/ct2/show/NCT02996110.

  62. https://clinicaltrials.gov/ct2/show/NCT04338269.

  63. https://clinicaltrials.gov/ct2/show/NCT04195750.

  64. https://clinicaltrials.gov/ct2/show/NCT05012371.

  65. https://clinicaltrials.gov/ct2/show/NCT04846920.

  66. https://clinicaltrials.gov/ct2/show/NCT04714697.

  67. https://clinicaltrials.gov/ct2/show/NCT03945773.

  68. https://clinicaltrials.gov/ct2/show/NCT04203901.

  69. https://clinicaltrials.gov/ct2/show/NCT03798626.

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Authors and Affiliations

  1. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Talal El Zarif, Wenxin Xu & Bradley A. McGregor

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  1. Talal El Zarif
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  2. Wenxin Xu
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  1. Moores Cancer Center, University of California San Diego, La Jolla, CA, USA

    Rana R. McKay

  2. Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Eric A. Singer

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El Zarif, T., Xu, W., McGregor, B.A. (2023). Subsequent Line Systemic Treatment Options for Advanced Renal Cell Carcinoma. In: McKay, R.R., Singer, E.A. (eds) Integrating Multidisciplinary Treatment for Advanced Renal Cell Carcinoma. Springer, Cham. https://doi.org/10.1007/978-3-031-40901-1_13

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