Oncology Brothers: Practice-Changing Cancer Discussions Managing Toxicities of TKIs and HIF-2 inhibitor in Renal Cell Carcinoma (RCC)
Aug 7, 2025
In this insightful discussion, Dr. Monty Pal, a medical oncologist from City of Hope, shares his expertise on renal cell carcinoma treatment. He dives into the nuances of managing toxicities from tyrosine kinase inhibitors (TKIs) and HIF-2 alpha inhibitors, offering practical dosing strategies. The conversation highlights common side effects like hypertension and fatigue, and Dr. Pal provides invaluable clinical pearls for mitigating these issues while maintaining patients' quality of life. Discover effective management techniques for both first- and second-line therapies!
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Start At Label Dose And Encourage Early Calls
- Start recommended labelled doses for TKIs but monitor closely and be ready to reduce if needed.
- Tell patients to call early for toxicity and avoid trying to 'be a hero' with side effects.
Real‑World Cabozantinib Use And Expectations
- Monty frequently uses cabozantinib and often starts at 40 mg with immunotherapy but 60 mg as monotherapy.
- He meets patients frequently early and expects many will require dose reductions or breaks.
Dose Reduction Can Lower Efficacy
- Dose reductions often reduce efficacy and can produce less clinical benefit.
- The dose–response relationship exists across many TKIs, so lowering dose may compromise outcomes.