Page 20 - CUA KIDNEY CANCER HANDBOOK 2020

Second-line and Beyond g
Prior Immune Checkpoint Prior VEGF Prior Immune Checkpoint
Inhibitor Inhibitor Inhibitor and VEGF Inhibitor
Preferred options: Preferred options: Preferred option:
h
Cabozantinib OR Nivolumab OR Cabozantinib
Axitinib Cabozantinib
h
Other options: Other options: Other options:
Sunitinib OR Lenvatinib + Sunitinib OR
Pazopanib OR Everolimus OR PazopanibOR

i
Lenvatinib + Everolimus h Everolimus OR Axitinib OR
e
Axitinib Lenvatinib + Everolimus OR
Everolimus
a. Some intermediate-risk patients are candidates for cytoreductive nephrectomy (per KCRNC)
b. Combination approved in Canada in December 2019
c. Awaiting mature overall survival data
d. No randomized control trial
e. Not approved in Canada (as of Mar. 2020)
f. Supported by phase II data only; approved for use but not funded in first line
g. If not used prior
h. In second or later lines, approved in Canada after one prior VEGF inhibitor therapy
i. Monitor closely for first 12 weeks for liver toxicity

14 Practical Approaches to Managing Advanced Kidney Cancer