ADVANCED RENAL CELL CARCINOMA AND SYSTEMIC THERAPY

Question 1

What is the the most fundamental and critical molecular alteration in ccRCC?

Answer 1

Disruption of VHL through mutation, deletion, or methylation

Question 2

What are the 6 inhibitors of VEGFR or the TKIs?

Answer 2

1. Sunitinib
2. Pazopanib
3. Sorafenib
4. Axitinib
5. Cabozantinib
6. Lenvantinib

Question 3

what is the only VEGF inhibitor?

Answer 3

BEVACIZUMAB

Question 4

What targets the VEGF ligand, preventing angiogenesis?

Answer 4

VEGF inhibitor (BEVACIZUMAB)

Question 5

What are the 2 most common AE of VEGF inhibitors?

Answer 5

1. HPN
2. PROTEINURIA

Question 6

What are the 2 first-generation mTOR inhibitors?

Answer 6

1. Everolimus
2. Temsirolimus

Question 7

What does the first-generation mTOR inhibitors (everolimus, temsirolimus) suppress?

Answer 7

mTORC1 activity alone

Question 8

What does the next generation of mTOR inhibitors suppress?

Answer 8

mTORC2 and PI3K pathway

Question 9

What receptors sustain normal autoregulation of our immune system by downregulating T-cell and associated immune cell (macrophage, natural killer cell) activity?

Answer 9

Immune checkpoint receptors

Question 10

What are the two receptor proteins regulating adaptive immunity used in cancer treatment?

Answer 10

• CTLA-4
• PD-1

Question 11

What immune checkpoint inhibitor is CTLA-4−directed antibody?

Answer 11

Ipilimumab

Question 12

What immune checkpoint inhibitor is PD-1−directed antibody?

Answer 12

NIVOLUMAB

Question 13

What are the 2 checpoint inhibitors used to treat RCC?

Answer 13

1. IPILIMUMAB
2. NOVILUMAB

Question 14

What is considered a standard of care in patients with metastatic ccRCC?

Answer 14

Systemic VEGF-targeted therapy
(e.g., sunitinib, pazopanib, bevacizumab/interferon)