New results from the ASCO Genitourinary Cancers Symposium highlight advances in renal cell carcinoma (RCC) treatment, focusing on the use of belzutifan. In the adjuvant setting, the LITESPARK-022 trial showed that combining belzutifan with pembrolizumab improved disease-free survival compared with pembrolizumab alone. While high-grade side effects were more frequent, most patients tolerated treatment, suggesting this combination could become a new standard for high-risk post-surgery patients.
For metastatic RCC, treatment is increasingly tailored to disease aggressiveness. Patients with indolent or low-volume tumors may benefit from dual immunotherapy like ipilimumab plus nivolumab, while aggressive, high-volume tumors are often treated with immunotherapy plus targeted agents such as lenvatinib or cabozantinib to rapidly reduce tumor burden. VEGF-targeted therapy alone remains an option for favorable-risk patients.
In the second-line setting, the LITESPARK-011 trial found that lenvatinib combined with belzutifan improved progression-free survival and response rates over cabozantinib alone, though cardiac monitoring is needed. Emerging biomarker strategies, including RNA sequencing in the BIONIKK trial, aim to personalize therapy by classifying tumors as immunogenic or angiogenic.