(UroToday.com) There have been transformational changes in first-line therapy for patients with metastatic renal cell carcinoma (RCC) in the past three years. Foremost among these is the move from monotherapy to combination approaches. While CheckMate 214 first brought combination therapy with dual checkpoint inhibition (nivolumab and ipilimumab) to the forefront, subsequent studies have examined combinations of immune checkpoint inhibitors and tyrosine-kinase inhibitors in the first-line setting. One such combination is nivolumab and cabozantinib which, in the CheckMate 9ER trial (NCT03141177), was found to significantly improve progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) as first-line therapy for patients with advanced RCC. In general, in nivolumab and cabozantinib were well tolerated with low rates of treatment-related discontinuations, indicating successful adverse event (AE) management with dose modification to maintain tolerability. In the Kidney and Bladder Poster session at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, Dr. Shah performed an exposure-response analysis of cabozantinib exposure on efficacy and safety outcomes within the context of the CheckMate 9ER trial.