2022 - Medical Therapy for Renal Cell Flashcards
What were the key results and FDA approval date for CheckMate 214?
Nivolumab + Ipilimumab vs. Sunitinib. ORR: 42.1% vs 26.3%, CR: 10% vs 1%, OS: 47 vs 26.6 months. FDA approval: April 2018.
What were the key results and FDA approval date for Keynote-426?
Axitinib + Pembrolizumab vs. Sunitinib. ORR: 60% vs 40%, CR: 9% vs 3%, PFS: 15.4 vs 11.1 months, OS: not reached vs 35.7 months. FDA approval: April 2019.
What were the key results and FDA approval date for JAVELIN Renal 101?
Axitinib + Avelumab vs. Sunitinib. ORR in PD-L1+: 55% vs 25.5%, CR: 4.4% vs 2.1%, PFS PD-L1+: 13.8 vs 7.2 months. FDA approval: May 2019.
What were the key results and FDA approval date for CheckMate 9ER?
Nivolumab + Cabozantinib vs. Sunitinib. ORR: 55.7% vs 27.1%, CR: 8.0% vs 4.6%, PFS: 16.3 vs 8.3 months. FDA approval: January 2021.
What were the key results and FDA approval date for CLEAR?
Lenvatinib + Everolimus or Lenvatinib + Pembrolizumab vs. Sunitinib. ORR: 70.1% vs 36.1%, CR: 16.1% vs 4.2%, PFS: 23.9 vs 9.2 months. FDA approval: August 2021.
What were the key results for Immotion 151, and was it submitted to the FDA?
Atezolizumab + Bevacizumab vs. Sunitinib. ORR in PD-L1+: 43% vs 35%, PFS in PD-L1+: 12.2 vs 7.7 months. Not submitted to the FDA.
What are the preferred regimens for favorable and poor/intermediate risk clear cell kidney cancer?
Favorable risk: Axitinib + Pembrolizumab, Pazopanib, Sunitinib.
Poor/Intermediate risk: Ipilimumab + Nivolumab, Axitinib + Pembrolizumab, Cabozantinib.
What are the other recommended regimens for favorable and poor/intermediate risk clear cell kidney cancer?
Favorable risk: Ipilimumab + Nivolumab, Axitinib + Avelumab, Cabozantinib (category 2B), Pazopanib, Sunitinib.
Poor/Intermediate risk: Axitinib + Avelumab.
What regimens are considered useful in certain circumstances for favorable and poor/intermediate risk clear cell kidney cancer?
Favorable risk: Active surveillance, High dose IL-2, Axitinib.
Poor/Intermediate risk: Temsirolimus, Axitinib (category 2B), High dose IL-2.
What updates are expected in the NCCN regimens with later 2021 versions?
Expect updates with CheckMate 9ER and CLEAR trials based on data from table 1.
What are the preferred regimens for subsequent therapy for clear cell kidney cancer?
Cabozantinib (category 1), Nivolimab (category 1), Ipilimumab + Nivolumab (category 1).
What are the other recommended regimens for subsequent therapy for clear cell kidney cancer?
Axitinib (category 1), Lenvatinib + Everolimus (category 1), Axitinib + Pembrolizumab, Everolimus, Pazopanib, Sunitinib, Axitinib + Avelumab (category 3).
What is the annual estimate of new cases and deaths from kidney and renal pelvis cancer in the U.S.?
74,000 new cases and 15,000 deaths.
What percentage of kidney cancer cases is represented by RCC?
Over 90%.
According to the SEER data, what percentage of RCC patients present with metastatic disease, and what is the 5-year survival rate?
16% present with metastatic disease, and the 5-year survival rate is 12%.
Why is it essential for the urology community to be aware of the rapid advancements in kidney cancer treatment?
Because 30%-40% of high-risk stage 2 and 3 cases may recur and require systemic treatment, and many patients ultimately need systemic treatment.
What classic symptoms can still present with advanced RCC?
Flank pain, hematuria, and palpable abdominal renal mass.
Why is a detailed family history important in RCC diagnosis, and what percentage may have a hereditary component?
It’s important to identify potential hereditary syndromes, especially in those diagnosed at a young age. Approximately 5%-8% of RCC may have a hereditary component.
What are the preferred imaging techniques for detecting and staging RCC?
Multiphased abdominal CT or MRI, chest CT for high-risk patients, bone scan for specific cases, and brain MRI if neurological symptoms are present.
What are the two major risk models for stratifying patients with advanced RCC?
The Memorial Sloan Kettering Cancer Center Prognostic Model and the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) Criteria.
What recent trials suggest that operating on poor surgical candidates with RCC may lead to worse outcomes?
The CARMENA and SURTIME trials.
What are some of the options for managing both symptomatic and asymptomatic oligometastatic RCC disease?
Resection or metastasectomy, complete surgical resection of metastases, percutaneous ablation, and stereotactic radiation.
What classic signs may indicate advanced RCC, and what specific signs could signify concerns for an obstructive tumor thrombus?
Classic signs include flank pain, hematuria, and palpable abdominal renal mass. Varicoceles, ascites, caput medusae, and lower extremity edema can signify concerns for an obstructive tumor thrombus.
What considerations are necessary when evaluating RCC in younger patients (age ≤46 years), and what percentage of RCC may have a hereditary component?
Considerations include suspicion for hereditary syndromes like hereditary leiomyomatosis and RCC or Birt-Hogg-Dubé, and a detailed family history. Approximately 5%-8% of RCC may have a hereditary component.
What imaging techniques are preferred for new renal tumors, and what are the considerations for chest imaging and high-risk patients?
Multiphased abdominal CT or MRI is preferred. Chest CT is more accurate for high-risk patients with a large renal mass. Second-generation macrocyclic MRI contrast agents are safer for moderate and severe renal dysfunction.