RCC Flashcards
What is the percent surviving at 5 years for RCC?
75%
What are the risk factors of RCC?
Obesity
Smoking
HTN
Occupational exp, VHL disease
T/F 40% of VHL patients will develop RCC
True
T/F 60% of renal cancers are RCC
False
90%
Describe sporadic RCC
single tumor
one kidney
older patient
known risk factors
Describe hereditary RCC
numerous cystic lesions
affects both kidneys
T/F the majority of RCC patients are symptomatic
false
Asymptomatic
What is the classic triad of symptoms in RCC?
Hematuria
Flank pain
Palpable abdominal mass
Metastatic disease in RCC symptoms
Bone pain
Adenopathy
Pulmonary symptoms
T/F screening is recommended for everyone for RCC
False
Not for general population!
T/F you must biopsy for diagnosis in RCC
False
Radiographic evaluation is usually good enough!
Stage I RCC
tumor = 7 cm
Limited to kidney
Stage II RCC
tumor > 7 cm
Limited to kidney
Stage III RCC
Limited to kidney with metastasis to regional lymph nodes
OR
tumor extends into major veins or perinephric tissues
Stage IV RCC
Tumor invades beyond Gerota’s fascia
Or
tumor with distant metastasis
T/F complete resection is needed for a cure in localized and advanced RCC
False!
For cure = localized
For disease control = advanced
T/F radiation is only palliative for localized and advanced RCC
True
Radical nephrectomy
full removal of kidney + fat + adrenal gland + reginal lymph nodes
Risks of radical nephrectomy
CKD
CVD
When would you use partial nephrectomy?
If radical would lead to dialysis
Tumor on both kidneys
Already have 1 kidney
Poor renal fcn
T/F adjuvant therapy is a must in RCC
False
No benefit!
T/F there is a minimal role for traditional chemo in advanced RCC
true
When can you use IL-2 in RCC?
excellent performance status and normal organ function
**lots of toxicities, so given in ICU usually
*Nivolumab MOA
PD-1 inhibitor
Binds receptor on T cells
Block ligands PD-L1 and PD-L2 from binding
1st line therapy for RCC
Ipilimumab + nivolumab
Ipilimumab MOA
CTLA-4 inhibitor
*Immunotherapy ADEs
Peripheral edema Pruritis, rash N/D Colitis Anemia Cough, pneumonitis Hypothyroidism Encephalitis Hepatitis, nephritis
*Management of immune-related ADEs
Systemic steroids: prednisone 0.5 - 2 mg/kg/day
*Pembrolizumab MOA
anti-PD1 inhibitor
*1st line therapy for metastatic RCC preferred by NCCN
Pembrolizumab + axitinib )
*Who can you use pembrolizumab in?
favorable or poor/intermediate risk
*What are the 5 class ADEs of TKIs?
- dermatologic (rash, hand-foot)
- GI
- Hematologic
- Hepatic
- Cardiac: HTN
*Management of hand-foot
Control calluses
Comfort with cushions
Cover with creams
avoid vigorous exercise/activity that puts stress on hands or feet
When is lenvatinib used?
only in combo with everolimus
When would you use pazopanib?
has less derm toxicities!
Which would you choose?
Metastatic RCC worried about dermatological issues
Pazopanib
Which of these drugs is NOT metabolized by CYP 3A4?
Pembrolizumab, levantinib, sunitinib, axitinib
Pembrolizumab
Important pearl for cabozantinib
tablets and capsules are NOT interchangeable
Increased nausea
What was the first FDA approved biological antiangiogenic agent for RCC?
bevacizumab
BBW bevacizumab
impaired wound healing
GI perforation
SAH
pulmonary hemorrhage
Main ADEs of temsirolimus
metabolic: hyperglycemia, hypercholesteremia, hyperlipidemia
Sarcomatoid variant RCC
aggressive form of RCC
poor prognosis
*chemo had shown activity here!
When would you use traditional chemo in RCC?
sarcomatoid
Hallmark of clear cell RCC
inactivation of VHL
What is the treatment of choice for all stages in RCC?
surgery
