Management of Neutropenia in Metastatic Renal Cell Carcinoma

Adverse Event Profile

• The combination of lenvatinib with pembrolizumab has shown higher rates of grade 3-4 adverse events (82.4%) compared to sunitinib monotherapy (71.8%) 1, 2
• Previous exposure to pembrolizumab may have primed the immune system, potentially exacerbating the myelosuppressive effects when lenvatinib was added 3

Clinical Trial Outcomes

• In the CLEAR trial, adverse events led to discontinuation of lenvatinib in 25.6% of patients and required dose reductions in 68.8% of patients receiving lenvatinib plus pembrolizumab 4, 5
• The lenvatinib-pembrolizumab combination showed significant survival benefit in the CLEAR trial (median PFS 23.9 months vs 9.2 months with sunitinib) 6

Alternative Regimens

• If neutropenia remains unmanageable, consider switching to alternative regimens such as nivolumab plus cabozantinib or axitinib plus pembrolizumab 7