Therapeutic sequencing and role of cabozantinib after immunotherapy in metastatic renal cell carcinoma.

The introduction of immunotherapy, either as monotherapy or in combination with tyrosine kinase inhibitors (TKIs), has profoundly reshaped the first-line treatment of metastatic renal cell carcinoma. Nevertheless, most patients eventually experience disease progression, highlighting the unmet clinical need for effective therapeutic strategies in the post-immunotherapy setting. Cabozantinib, a multikinase TKI targeting VEGFR, MET, and AXL, represents one of the most established treatment options in this context. This mini-review summarizes the biological rationale, key clinical evidence, and the most recent data presented at major international congresses, with a specific focus on the positioning of cabozantinib after failure of immunotherapy-based regimens or immune-TKI combinations.