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ASCO 2026 | Balancing efficacy and tolerability in second-line RCC treatment

Andrew Hahn, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the emerging data informing second-line treatment choices for patients with renal cell carcinoma who progress on certain therapies. Trade-offs between efficacy and tolerability exist in the lenvatinib plus everolimus combination based on the Phase II LenCabo trial (NCT05012371). Lenvatinib and belzutifan, assessed in the LITESPARK-011 trial (NCT04586231) may be preferred for prioritizing efficacy, while cabozantinib may be a better option for patients where tolerability is a concern. This interview took place during the 2026 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.

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Transcript

There’s a lot of converging data right now to inform what second-line treatment we’re using when patients progress on either nivolumab plus ipilimumab, adjuvant pembrolizumab, or pembrolizumab plus axitinib. You have the Len-Cabo study, our study, that showed improved efficacy with lenvatinib plus everolimus, but some trade-off with worsening body composition and tolerability with that combination compared to cabozantinib...

There’s a lot of converging data right now to inform what second-line treatment we’re using when patients progress on either nivolumab plus ipilimumab, adjuvant pembrolizumab, or pembrolizumab plus axitinib. You have the Len-Cabo study, our study, that showed improved efficacy with lenvatinib plus everolimus, but some trade-off with worsening body composition and tolerability with that combination compared to cabozantinib. Additionally, you have the KEYNOTE-361 study is not mentioned but another study is the LightSpark 11 study that is not the actual name but is actually called the KEYNOTE-581/LEAP-011 or possibly another, that showed improved progression-free survival and objective response rate with lenvatinib plus belzutifan when compared to cabozantinib. So you now have three options to choose from. And I think my takeaway from our studies is that if you’re wanting to prioritize efficacy, which you likely are in the majority of patients that you’re treating, you probably should go with the lenvatinib-based doublet for those patients. But for those patients, maybe older patients, frail patients, patients who’ve had a lot of toxicity with prior therapies, where you’re wanting to prioritize tolerability, our data argues, the quality of life data from the actual study argue that cabozantinib is the better choice in that situation.

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