Renal Cell Carncinoma

Question 1

T/F: Renal cell carcinoma is the most common type of kidney cancer and is highly vascular

Answer 1

True

Question 2

What are the risk factors for developing renal cell carcinoma

Answer 2

Smoking, obesity, hypertension, familial syndromes (Von Hippel-Lindau syndrome and Birt Hogg Dube), enviormental exposures, phenacetin

Question 3

What are the two most common symptoms of renal cell carcinoma

Answer 3

Fatigue and flank pain

Question 4

What are the differences in the kidney tumor from Stage 1 to Stage 4

Answer 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

Question 5

What is the best way to deal with Renal Cell Carcinoma in the first 3 stages

Answer 5

Partial or Radical nephrectomy

Question 6

What are the risk criteria in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk model

Answer 6

Time to diagnosis to treament in years, Karnofsky Perfomance status, Corrected serum calcium, serum hemoglobin, neutrophil count, platelet count

Question 7

Once the risk status is tallied for IMDC what are the three categories

Answer 7

Favorable: 0, Intermediate: 1 to 2, Poor: Greater than or equal to 3

Question 8

If a patient has favorable risk from the IMDC risk model what is preferred for their stage 4 RCC

Answer 8

Axitinib PLUS pembrolizumab, Pazopanib, Sunitinib

Question 9

If a patient has favorable risk from the IMDC risk model what are OTHER recommended chemotherapy options for their Stage 4 RCC

Answer 9

Ipilumumab PLUS nivolumumab, cabozantinib, axitinib PLUS avelumab

Question 10

If a patient has intermediate to poor risk from the IMDC risk model what is preferred for their Stage 4 RCC

Answer 10

Ipilumumab PLUS nivolumumab, Axitinib PLUS pembrolizumab, Cabozantinib

Question 11

If a patient has intermediate to poor risk from the IMDC risk model what are OTHER recommended chemotherapy options for their Stage 4 RCC

Answer 11

Pazopanib, Sunitinib, Axitinib PLUS avelumab

Question 12

What is the preferred regimen if a patient relapses form RCC

Answer 12

Cabozatininb, Nivolumab, Ipilumumab PLUS nivolumab

Question 13

What are the tyrosine kinase inhibitors

Answer 13

Sunitinib, Sorafenib, Cabozatinib, Pazopanib, Axitinib, Lenvatinib

Question 14

Which TKI has the most myelosuppresive toxicities, what is done to possibly avoid this

Answer 14

Sunitinib, 2 weeks off after 4 weeks on

Question 15

Which TKIs should either be taken ONE HOUR BEFORE a meal or TWO HOURS after

Answer 15

Pazopanib, Cabozatinib, Sorafenib

Question 16

What are the four most common toxicites for TKI, others

Answer 16

Diarrhea, Hand foot syndrome, hypertension, fatigue/ hypothyroidism, impaired wound healing, liver dysfunction

Question 17

Which TKI is known to have moderate to high emetogenicity

Answer 17

Lenvatinib

Question 18

If a patient has Grade 3 toxicity due to TKI what should be done and how should the dose be modified

Answer 18

Interruption until recovery to Grade 2/ 1st episode: restart at full dose, 2nd episode: reduce dose until adverse effects are at grade 2

Question 19

If a patient has grade 3-4 toxicity due to TKI what should be and how should the dose be modified

Answer 19

Interruption/ Consider permanent interruption or reduction

Question 20

What are the TKI that have no drug drug interactions

Answer 20

Sorafenib and Lenvatinib

Question 21

What are the TKI that have drug-drug interactions, due to what enyzme

Answer 21

Sunitinib, Cabozanitinib, Pazopanib, Axitinib/ CYP3A4

Question 22

Which TKIs should avoid CYP3A4 inducers

Answer 22

Axitinib and Pazopanib

Question 23

Which TKIs should avoid CYP3A4 inhibitors

Answer 23

Pazopanib and Axitinib

Question 24

Which TKIs should lower the dose when used with CYP3A4 inhibitors, increase when used with CYP3A4 inducers

Answer 24

Sunitinib, Cabozanitib, pazopanib, and axitinib

Question 25

What are the mTOR inhibitors used in RCC

Answer 25

Everolimus (in combination with lenvatinib or alone) and Temsirolimus

Question 26

What is the most common toxicity

Answer 26

Thrombocytopenia and neutropenia (more in temsirolimus)

Question 27

What causes drug-drug interactions with the mTOR inhibitors

Answer 27

3A4 and p-gp substrates

Question 28

What class of drug is Avelumab

Answer 28

PD-L1 inhibitor

Question 29

What class of drug is Ipililumab, Nivolumab

Answer 29

CTLA-4 inhibitor, PD-1 inhibitor