RCC Flashcards
IMDC interpretation
0 = favorable
1-2 = intermediate
3 or more = poor
Approved IO/TKI regimens
len/pembro
cabo/nivo
axi/pembro
Indications for germline testing in RCC
- multiple masses (multifocal disease)
- bilateral
- 1 or more first or second degree relatives with RCC
- age <46 at diagnosis
Genetic conditions associated with RCC
VHL
Hereditary papillary syndrome
Birt Hogg Dube
Hereditary leiomyomatosis
Tuberous sclerosis
Succinate dehydrogenase
BAP1
Genetic syndrome associated with MET mutation
Hereditary papillary syndrome
Approved treatment for RCC related to hereditary leiomyomatosis
bevacizumab + erlotinib
medullary RCC treatment
- chemo based- carbo/gem (confirm)
Positive stains in RCC
PAX2
PAX8
Size threshold at which partial nephrectomy is preferred
<7 cm
Size threshold for ablation
<5 cm
IMDC criteria
KPS <80%
Time from diagnosis to treatment <1 year
Hgb <lower> upper limit of normal
platelets > upper limit of normal
corrected calcium > upper limit of normal</lower>
VEGF TKI SE’s
- HTN
- stomatitis
- LFT elevation
*thyroid dysfunction - hand/foot syndrome
- etc.
indications for adjuvant pembro
Independent of PD-L1 (subgroups didn’t differ substantially in Keynote) AND intermediate-high or high risk for recurrence (T2 with nuclear grade 4 or sarcomatoid differentiation, T3a or higher, node positive or M1 NED (within 1 yr)) (see pearls – better HR in PDL1 positive OR >30% at 5 years), especially if sarcomatoid (more responsive),
IMDC categories
*need to know since will just give you variables
- less than 1 year from diagnosis to systemic therapy
- KS PS less than 80%
- hgb < ULN
- calcium > ULN
- neutrophils > ULN
- platelets > ULN
Location of VHL gene
Chromosome 3
