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Bradley G. Somer, MD, an associate professor of hematology/oncology and head of strategic expansion/development at the University of Tennessee West Cancer Center, discusses treatment selection considerations in renal cell carcinoma (RCC).

In addition to a patient’s risk status, physicians should look at other clinical criteria such as the general health of the patient and their immune factors. The natural biology of the tumor should also be considered, because metastatic sites are important in RCC, says Somer.

For example, a small number of pulmonary metastases with otherwise good risk factors indicates that the patient is angiogenically driven. In that case, surveillance may be sufficient for the patient, adds Somer. However, patients with liver metastases, bone metastases, and brain metastases should receive an aggressive treatment in an attempt to prevent further progression.

Physicians are still searching for biomarkers and other molecular markers that could further direct treatment decisions. PD-L1, although effective in lung and breast cancers, has yet to prove beneficial in RCC, explains Somer.