RCC

Question 1

What is the percent surviving at 5 years for RCC?

Answer 1

75%

Question 2

What are the risk factors of RCC?

Answer 2

Obesity
Smoking
HTN

Occupational exp, VHL disease

Question 3

T/F 40% of VHL patients will develop RCC

Answer 3

True

Question 4

T/F 60% of renal cancers are RCC

Answer 4

False

90%

Question 5

Describe sporadic RCC

Answer 5

single tumor
one kidney
older patient
known risk factors

Question 6

Describe hereditary RCC

Answer 6

numerous cystic lesions

affects both kidneys

Question 7

T/F the majority of RCC patients are symptomatic

Answer 7

false

Asymptomatic

Question 8

What is the classic triad of symptoms in RCC?

Answer 8

Hematuria
Flank pain
Palpable abdominal mass

Question 9

Metastatic disease in RCC symptoms

Answer 9

Bone pain
Adenopathy
Pulmonary symptoms

Question 10

T/F screening is recommended for everyone for RCC

Answer 10

False

Not for general population!

Question 11

T/F you must biopsy for diagnosis in RCC

Answer 11

False

Radiographic evaluation is usually good enough!

Question 12

Stage I RCC

Answer 12

tumor = 7 cm

Limited to kidney

Question 13

Stage II RCC

Answer 13

tumor > 7 cm

Limited to kidney

Question 14

Stage III RCC

Answer 14

Limited to kidney with metastasis to regional lymph nodes
OR
tumor extends into major veins or perinephric tissues

Question 15

Stage IV RCC

Answer 15

Tumor invades beyond Gerota’s fascia
Or
tumor with distant metastasis

Question 16

T/F complete resection is needed for a cure in localized and advanced RCC

Answer 16

False!
For cure = localized
For disease control = advanced

Question 17

T/F radiation is only palliative for localized and advanced RCC

Answer 17

True

Question 18

Radical nephrectomy

Answer 18

full removal of kidney + fat + adrenal gland + reginal lymph nodes

Question 19

Risks of radical nephrectomy

Answer 19

CKD

CVD

Question 20

When would you use partial nephrectomy?

Answer 20

If radical would lead to dialysis
Tumor on both kidneys
Already have 1 kidney
Poor renal fcn

Question 21

T/F adjuvant therapy is a must in RCC

Answer 21

False

No benefit!

Question 22

T/F there is a minimal role for traditional chemo in advanced RCC

Answer 22

true

Question 23

When can you use IL-2 in RCC?

Answer 23

excellent performance status and normal organ function

**lots of toxicities, so given in ICU usually

Question 24

*Nivolumab MOA

Answer 24

PD-1 inhibitor
Binds receptor on T cells
Block ligands PD-L1 and PD-L2 from binding

Question 25

1st line therapy for RCC

Answer 25

Ipilimumab + nivolumab

Question 26

Ipilimumab MOA

Answer 26

CTLA-4 inhibitor

Question 27

*Immunotherapy ADEs

Answer 27

``` Peripheral edema Pruritis, rash N/D Colitis Anemia Cough, pneumonitis Hypothyroidism Encephalitis Hepatitis, nephritis ```

Question 28

*Management of immune-related ADEs

Answer 28

Systemic steroids: prednisone 0.5 - 2 mg/kg/day

Question 29

*Pembrolizumab MOA

Answer 29

anti-PD1 inhibitor

Question 30

*1st line therapy for metastatic RCC preferred by NCCN

Answer 30

Pembrolizumab + axitinib )

Question 31

*Who can you use pembrolizumab in?

Answer 31

favorable or poor/intermediate risk

Question 32

*What are the 5 class ADEs of TKIs?

Answer 32

1. dermatologic (rash, hand-foot) 2. GI 3. Hematologic 4. Hepatic 5. Cardiac: HTN

Question 33

*Management of hand-foot

Answer 33

Control calluses Comfort with cushions Cover with creams avoid vigorous exercise/activity that puts stress on hands or feet

Question 34

When is lenvatinib used?

Answer 34

only in combo with everolimus

Question 35

When would you use pazopanib?

Answer 35

has less derm toxicities!

Question 36

Which would you choose? | Metastatic RCC worried about dermatological issues

Answer 36

Pazopanib

Question 37

Which of these drugs is NOT metabolized by CYP 3A4? | Pembrolizumab, levantinib, sunitinib, axitinib

Answer 37

Pembrolizumab

Question 38

Important pearl for cabozantinib

Answer 38

tablets and capsules are NOT interchangeable | Increased nausea

Question 39

What was the first FDA approved biological antiangiogenic agent for RCC?

Answer 39

bevacizumab

Question 40

BBW bevacizumab

Answer 40

impaired wound healing GI perforation SAH pulmonary hemorrhage

Question 41

Main ADEs of temsirolimus

Answer 41

metabolic: hyperglycemia, hypercholesteremia, hyperlipidemia

Question 42

Sarcomatoid variant RCC

Answer 42

aggressive form of RCC poor prognosis *chemo had shown activity here!

Question 43

When would you use traditional chemo in RCC?

Answer 43

sarcomatoid

Question 44

Hallmark of clear cell RCC

Answer 44

inactivation of VHL

Question 45

What is the treatment of choice for all stages in RCC?

Answer 45

surgery