Optimal Duration of Therapy in Metastatic RCC: Exploring Treatment-Free Survival with Checkpoint Inhibitors

The optimal duration of treatment for patients with metastatic renal cell carcinoma (mRCC) on dual immune checkpoint inhibitor (ICI) therapy remains unknown. However, there is evolving evidence that a portion of patients who achieve a complete or partial response will have a durable response, even after therapy discontinuation, leading to prolonged treatment-free survival (TFS). TFS with dual ICI is a phenomenon not seen with targeted agents and has the potential to improve patient reported outcomes and quality of life, without altering overall survival (OS). Despite this understanding, treatment of mRCC remains lifelong, as there has yet to be a prospective, randomized control trial to evaluate this key question. In this review, we analyze available studies in patients with mRCC on dual ICI therapy and propose considerations for early treatment discontinuation. Additionally, we discuss vital questions and the next steps to help physicians and patients navigate these challenging treatment decisions.