A trial investigating intermittent versus continuous axitinib in metastatic RCC addresses a major clinical challenge: the significant toxicity and impaired quality of life from continuous TKI therapy. Proving non-inferiority for an intermittent schedule could fundamentally change patient management and improve long-term tolerability.
Upcoming trials like RETAIN and IMVigor011 are using circulating tumor DNA (ctDNA) to guide complex treatment choices in muscle-invasive bladder cancer. This biomarker-driven approach aims to personalize therapy, potentially enabling bladder preservation for some patients and identifying others who need additional adjuvant treatment.
Major trials in prostate (PEACE-2), bladder (Keynote B15), and kidney cancer (LITESPARK-022) showcase a common strategy: moving potent systemic therapies into earlier, curative-intent settings. This approach of using the best drugs sooner aims to improve long-term outcomes, though it also raises questions about toxicity and overtreatment.
The PANFA trial's investigation of Actinium-225, an alpha-emitter, signals the next wave of radioligand therapy. Unlike the current beta-emitter standard Lutetium, alpha-emitters offer a shorter range but more potent cell-killing effect, positioning them as a promising treatment for patients who have already progressed on existing therapies.