- Unresectable, locally advanced or metastatic clear cell renal cell carcinoma (RCC).
- Disease progression on or after having received systemic treatment with
anti-programmed cell death-1/ligand 1 (PD-1/L1) for locally advanced or metastatic
- Measurable disease per RECIST 1.1 criteria as assessed by local study investigator.
- Karnofsky performance status (KPS) score of at least 70% assessed within 10 days
- Can submit an archival tumor tissue sample or newly obtained core or excisional biopsy
of a tumor lesion not previously irradiated.
- Received no more than 2 prior systemic regimens for locally advanced or metastatic
- Received only 1 prior antiPD-1/L1 therapy for locally advanced or metastatic RCC.
- A male participant is eligible to participate if he is abstinent from heterosexual
intercourse or agrees to use contraception during the intervention period and for at
least 7 days after the last dose of belzutifan or lenvatinib in the
belzutifan+lenvatinib arm, whichever occurs last, and 23 days after the last dose of
- A female participant is eligible to participate if she is not pregnant, not
breastfeeding, and at least 1 of the following conditions applies: Not a woman of
childbearing potential (WOCBP) or a WOCBP who agrees to follow the contraceptive
guidance during the intervention period and for at least 30 days after the last dose
of study intervention in the belzutifan+ lenvatinib arm, or 120 days after the last
dose of study intervention in the cabozantinib arm.
- A WOCBP must have a negative highly sensitive pregnancy test (urine or serum) within
24 hours before the first dose of study intervention.
- Adequately controlled blood pressure.
- Adequate organ function.
- Is a WOCBP who has a positive urine pregnancy test within 24 hours before the first
dose of study intervention.
- Hypoxia (pulse oximeter reading <92% at rest), requires intermittent supplemental
oxygen, or requires chronic supplemental oxygen.
- Known additional malignancy that is progressing or has required active treatment
within the past 3 years except for basal cell carcinoma of the skin, squamous cell
carcinoma of the skin, or carcinoma in situ (eg, breast carcinoma, cervical cancer in
situ) that have undergone potentially curative therapy.
- Known central nervous system (CNS) metastases and/or carcinomatous meningitis.
- Clinically significant cardiac disease within 6 months of first dose of study
- Prolongation of QTc interval to >480 ms.
- Symptomatic pleural effusion (e.g.,cough, dyspnea, pleuritic chest pain) that is not
- Pre-existing ≥Grade 3 gastrointestinal or nongastrointestinal fistula.
- Moderate to severe hepatic impairment.
- History of significant bleeding within 3 months before randomization.
- History of solid organ transplantation.
- Known psychiatric or substance abuse disorder that would interfere with cooperation
with the requirements of the study.
- Unable to swallow orally administered medication or has a gastrointestinal disorder
affecting absorption (e.g., gastrectomy, partial bowel obstruction, malabsorption).
- Known hypersensitivity or allergy to the active pharmaceutical ingredients or any
component of the study intervention formulations.
- Received colony-stimulating factors [eg, granulocyte colony-stimulating factor
(G-CSF), granulocyte macrophage colony-stimulating factor (GMCSF) or recombinant
erythropoietin (EPO)] within 28 days before randomization.
- Prior treatment with belzutifan or another hypoxia-inducible factor (HIF)-2α
- Prior treatment with lenvatinib.
- Prior treatment with cabozantinib.
- Currently participating in a study of an investigational agent or using an
- Active infection requiring systemic therapy.
- History of human immunodeficiency virus (HIV) infection.
- History of hepatitis B or known active hepatitis C infection.
- History or current evidence of any condition, therapy, or laboratory abnormality that
might confound the results of the study, interfere with the participant's
participation for the full duration of the study, or is not in the best interest of
the participant to participate, in the opinion of the treating investigator.