Renal Cell Carncinoma Flashcards
T/F: Renal cell carcinoma is the most common type of kidney cancer and is highly vascular
True
What are the risk factors for developing renal cell carcinoma
Smoking, obesity, hypertension, familial syndromes (Von Hippel-Lindau syndrome and Birt Hogg Dube), enviormental exposures, phenacetin
What are the two most common symptoms of renal cell carcinoma
Fatigue and flank pain
What are the differences in the kidney tumor from Stage 1 to Stage 4
Stage 1: Tumor is less than 7 cm
Stage 2: Tumor is greater than 7 cm
Stage 3: Tumor extends to major veins or invades adrenal glands or perinephric tissues BUT not beyond the Gerota’s fascia
Stage 4: Metastases
What is the best way to deal with Renal Cell Carcinoma in the first 3 stages
Partial or Radical nephrectomy
What are the risk criteria in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk model
Time to diagnosis to treament in years, Karnofsky Perfomance status, Corrected serum calcium, serum hemoglobin, neutrophil count, platelet count
Once the risk status is tallied for IMDC what are the three categories
Favorable: 0, Intermediate: 1 to 2, Poor: Greater than or equal to 3
If a patient has favorable risk from the IMDC risk model what is preferred for their stage 4 RCC
Axitinib PLUS pembrolizumab, Pazopanib, Sunitinib
If a patient has favorable risk from the IMDC risk model what are OTHER recommended chemotherapy options for their Stage 4 RCC
Ipilumumab PLUS nivolumumab, cabozantinib, axitinib PLUS avelumab
If a patient has intermediate to poor risk from the IMDC risk model what is preferred for their Stage 4 RCC
Ipilumumab PLUS nivolumumab, Axitinib PLUS pembrolizumab, Cabozantinib
If a patient has intermediate to poor risk from the IMDC risk model what are OTHER recommended chemotherapy options for their Stage 4 RCC
Pazopanib, Sunitinib, Axitinib PLUS avelumab
What is the preferred regimen if a patient relapses form RCC
Cabozatininb, Nivolumab, Ipilumumab PLUS nivolumab
What are the tyrosine kinase inhibitors
Sunitinib, Sorafenib, Cabozatinib, Pazopanib, Axitinib, Lenvatinib
Which TKI has the most myelosuppresive toxicities, what is done to possibly avoid this
Sunitinib, 2 weeks off after 4 weeks on
Which TKIs should either be taken ONE HOUR BEFORE a meal or TWO HOURS after
Pazopanib, Cabozatinib, Sorafenib
What are the four most common toxicites for TKI, others
Diarrhea, Hand foot syndrome, hypertension, fatigue/ hypothyroidism, impaired wound healing, liver dysfunction
Which TKI is known to have moderate to high emetogenicity
Lenvatinib
If a patient has Grade 3 toxicity due to TKI what should be done and how should the dose be modified
Interruption until recovery to Grade 2/ 1st episode: restart at full dose, 2nd episode: reduce dose until adverse effects are at grade 2
If a patient has grade 3-4 toxicity due to TKI what should be and how should the dose be modified
Interruption/ Consider permanent interruption or reduction
What are the TKI that have no drug drug interactions
Sorafenib and Lenvatinib
What are the TKI that have drug-drug interactions, due to what enyzme
Sunitinib, Cabozanitinib, Pazopanib, Axitinib/ CYP3A4
Which TKIs should avoid CYP3A4 inducers
Axitinib and Pazopanib
Which TKIs should avoid CYP3A4 inhibitors
Pazopanib and Axitinib
Which TKIs should lower the dose when used with CYP3A4 inhibitors, increase when used with CYP3A4 inducers
Sunitinib, Cabozanitib, pazopanib, and axitinib
What are the mTOR inhibitors used in RCC
Everolimus (in combination with lenvatinib or alone) and Temsirolimus
What is the most common toxicity
Thrombocytopenia and neutropenia (more in temsirolimus)
What causes drug-drug interactions with the mTOR inhibitors
3A4 and p-gp substrates
What class of drug is Avelumab
PD-L1 inhibitor
What class of drug is Ipililumab, Nivolumab
CTLA-4 inhibitor, PD-1 inhibitor
