Renal cell cancer

Question 1

What are some pathological types?

Answer 1

Clear cell 75% 
Papillary type 1 5%
Papillary type 2 10%
Chromophobe 
Oncocytoma

Question 2

Which gene is associated with clear cell?

Answer 2

von Hippel-Lindau - in 50-90%

Question 3

What does VHL mutation lead to?

Answer 3

Leads to angiogenesis

Question 4

What are some prognostic factors?

Answer 4

Motzer score (older)

IMDC - International metastatic RCC database consortium

Question 5

What is the current therapy for met RCC?

Answer 5

Tyrosine kinase inhibitors targeting VEGF-R

• Sunitinib
• Pazopanib
• Cabozantinib
• Lenvatinib
• Sorafenib

Immunotherapy - combination therapy

• PD1 - nivolumab
• CTLA-4 - ipilimumab

Mammalian target of rapamycin (mTOR) inhibitors

Question 6

What are toxicities of VEGF-R TKIs?

Answer 6

GI - mucositis, stomatitis, diarrhoea

Skin - hand-foot syndrome

Hypothyroidism

CV: CCF, MI, VTE, QT prolongation

Often lower grade

Question 7

What are the toxicities of immune checkpoint inhibitors?

Answer 7

Less common, unpredictable, often high grade

Question 8

What is first line for favourable risk and intermediate/poor rsk?

Answer 8

Favourable: sunitinib or pazopanib

Intermediate/poor: ipilimumab + nivolumab

Question 9

What is the role of cytoreductive nephrectomy in met. RCC?

Answer 9

TKI alone is non-inferior in CARMENA study

Consider in symptomatic primary
Or large primary, small metastatic burden