Renal cancer treatment in Spain: An online survey.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 397-397
Author(s):  
I. Duran ◽  
P. Sanchez Maurino ◽  
J. Garcia-Donas ◽  
D. R. Berthold
Keyword(s):  
Renal Cancer ◽  
Mechanism Of Action ◽  
Online Survey ◽  
Renal Carcinoma ◽  
Mtor Inhibitor ◽  
Clear Cell ◽  
Therapeutic Options ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

397 Background: Renal cancer incidence has increased in the last decades. Many treatment options have also been developed in this period. Knowledge about oncologists' attitudes in the management of this disease could help to implement better treatment protocols. Methods: An online survey about therapeutic options for renal cancer was developed by an expert committee. Oncologists with expertise on the treatment of genitourinary malignancies that fulfilled all inclusion criteria in Spain were listed (n=200) and 80 were randomly selected to complete the survey. Survey items considered renal carcinoma management in the daily clinical practice. The questionnaire posed multiple tests, protocols, or therapeutic options. Results: From the 80 selected oncologists, 53 responded to the online survey (66% response rate). The mean number of newly diagnosed cases per year was 201 (SD: 12) patients of whom 15 corresponded to renal carcinoma. Seventy nine per cent of participants reported to apply a protocol for treatment decisions, being the NCCN recommendations the most frequently followed (54.7%). Surprisingly, local or European recommendations were scarcely used. When asked about management of metastatic disease, most physicians (83%) reported that they would use sunitinib as the preferred first line treatment for good or intermediate prognosis patients. If further treatment would be required, 69.8% (n=37) and 79.2% (n=42) of oncologists would recommend a change in the mechanism of action by switching to an mTOR inhibitor (everolimus) for first and further relapses, respectively. Regarding the management of first line non-clear cell histologies, almost half of the physicians would utilize a TKI, while 38% would prefer an mTOR inhibitor. Conclusions: NCCN are the most frequently followed recommendations. There is agreement among oncologists about which treatment should be used for renal carcinoma after first line treatment failure by switching the mechanism of action of the selected treatment. The management of non-clear cell patients remains a matter of debate with no consensus among the participants. No significant financial relationships to disclose.

scholarly journals Pazopanib as a possible option for the treatment of metastatic non-clear cell renal carcinoma patients: a systematic review

2020 ◽  
Vol 12 ◽  
pp. 175883592091530
Author(s):  
Melissa Bersanelli ◽  
Matteo Brunelli ◽  
Letizia Gnetti ◽  
Umberto Maestroni ◽  
Sebastiano Buti
Keyword(s):  
Systematic Review ◽  
Renal Carcinoma ◽  
Clear Cell ◽  
Therapeutic Option ◽  
Comparable Efficacy ◽  
Line Treatment ◽  
Clear Cell Renal Carcinoma ◽  
First Line ◽  
Cell Renal Carcinoma ◽  
First Line Treatment

Background: Effective systemic treatment of non-clear cell renal carcinoma (nccRCC) is still an unmet clinical need, with few studies to support an evidence-based approach. To date, the only recommended standard first-line treatment is sunitinib. Pazopanib may also be used in nccRCC but its place in therapy is not clearly established. It has comparable efficacy and better tolerability than sunitinib in clear cell renal carcinoma. Our objective was to review the use of pazopanib in metastatic nccRCC. Methods: We conducted a systematic review according to PRISMA guidelines. Any type of study reporting the use of pazopanib in metastatic renal cell carcinoma including cases with non-clear cell histology was eligible. Results: In all, 15 studies were included in our analysis, including a total of 318 nccRCC patients treated with pazopanib. Most studies were retrospective ( n = 12); three were prospective trials. The specific outcomes of nccRCC patients were reported by four studies. Pazopanib alone as first-line treatment gave overall response rates ranging from 27% to 33%, disease control rates of 81–89%, median progression free survival of 8.1–16.5 months and median overall survival of 17.3–31.0 months. Grade 3–4 adverse events rates were 21–55%. Conclusion: The present review provides for the first time a systematic summary of evidence about the possible use of pazopanib as first-line treatment for nccRCC, with a favorable outcome despite the low strength of evidence. Pazopanib could be considered as a possible therapeutic option in this setting.

scholarly journals New Treatments for Renal Cell Carcinoma: Targeted Therapies

2009 ◽  
Vol 7 (6) ◽  
pp. 645-656 ◽  
Author(s):  
Philip J. Saylor ◽  
M. Dror Michaelson
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapies ◽  
Mtor Inhibitor ◽  
Kinase Inhibitors ◽  
Clear Cell ◽  
Treatment Options ◽  
Line Treatment ◽  
Second Line ◽  
Targeted Agents ◽  
First Line

Systemic treatment options for advanced renal cell carcinoma (RCC) have expanded considerably with the development of targeted therapies. Clear cell RCC commonly features mutation or inactivation of the von Hippel-Lindau gene and resultant overexpression of vascular endothelial growth factor (VEGF). The first drug to validate VEGF as a target in the treatment of clear cell RCC was the monoclonal antibody bevacizumab. Since then, anti-VEGF receptor therapy with multitargeted kinase inhibitors also has shown substantial efficacy. Sunitinib is now a standard first-line therapy for advanced disease and sorafenib is among the second-line treatment options. Other kinase inhibitors are in development. Mammalian target of rapamycin (mTOR) is a second validated therapeutic target as the mTOR inhibitor temsirolimus has been shown to prolong survival in first-line treatment of poor prognosis RCC of all histologies. Everolimus is an oral mTOR inhibitor and has been shown to prolong progression-free survival when used in second-line treatment. Non-clear cell and sarcomatoid RCC are both underrepresented in completed trials but are the subject of active research. Ongoing and planned studies will also evaluate the use of combinations of targeted agents, a strategy that is not advisable outside of clinical trials. Finally, postnephrectomy adjuvant treatment with targeted agents is not yet standard but is under investigation in phase III trials.

scholarly journals Individualizing Systemic Therapies in First Line Treatment and beyond for Advanced Renal Cell Carcinoma

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3750
Author(s):  
Yasir Khan ◽  
Timothy D. Slattery ◽  
Lisa M. Pickering
Keyword(s):  
Renal Cell ◽  
Checkpoint Inhibitors ◽  
Cell Cancer ◽  
Predictive Biomarkers ◽  
Therapeutic Options ◽  
Current Status ◽  
Vegf Receptor ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Therapeutic options for treating advanced renal cell cancer (RCC) are rapidly evolving. Vascular endothelial growth factor (VEGF)-directed therapy, predominantly VEGF receptor (VEGFr) tyrosine kinase inhibitors (TKIs) had been the most effective first line treatment since 2005 irrespective of International Metastatic RCC Database Consortium (IMDC) risk stratification. However, immune checkpoint inhibitors (ICI) have recently changed the treatment paradigm for advanced RCC particularly as the first-line systemic treatment modality. The combination of Ipilimumab and Nivolumab provides better disease control and long-term outcomes compared with the anti-VEGFr TKI Sunitinib for IMDC intermediate- to poor-risk patients and we now have the option of using ICI with TKI upfront for all IMDC risk groups. This poses a challenge for physicians, both to select the most suitable first line regimen and the most suitable subsequent therapy given the lack of data about sequencing in this setting. This treatment landscape is expected to become more complex with the emerging treatment options. Moreover, these therapeutic options cannot be generalized as significant variability exists between individual’s disease biologies and their physiologies for handling treatment adverse effects. Notable efforts are being made to identify promising predictive biomarkers ranging from neo-antigen load to gene expression profiling. These biomarkers need prospective validation to justify their utility in clinical practice and in treatment decision making. This review article discusses various clinicopathological characteristics that should be carefully evaluated to help select appropriate treatment and discusses the current status of biomarker-based selection.

scholarly journals Algorithms in the First‐Line Treatment of Metastatic Clear Cell Renal Cell Carcinoma—Analysis Using Diagnostic Nodes

2015 ◽  
Vol 20 (9) ◽  
pp. 1028-1035 ◽  
Author(s):  
Christian Rothermundt ◽  
Alexandra Bailey ◽  
Linda Cerbone ◽  
Tim Eisen ◽  
Bernard Escudier ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Line Treatment ◽  
First Line ◽  
Cell Renal Cell Carcinoma ◽  
Diagnostic Nodes ◽  
First Line Treatment

PDL-1 and PDL1 expressions in clear cell renal cell carcinoma (ccRCC) of metastatic patients with sunitinib first-line treatment.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e14002-e14002 ◽  
Author(s):  
Angélique Brunot ◽  
Jean-Christophe Bernhard ◽  
Mokrane Yacoub ◽  
Julien Edeline ◽  
Gregory Verhoest ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Line Treatment ◽  
First Line ◽  
Cell Renal Cell Carcinoma ◽  
First Line Treatment

Kidney cancer mobile application: Comparison of treatment choice of online and offline medical oncologists.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18240-e18240
Author(s):  
Ilya Tsimafeyeu ◽  
Andrey Vetluzhskiy
Keyword(s):  
Mobile Application ◽  
Clear Cell ◽  
Treatment Choice ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Online Tools ◽  
Medical Oncologists ◽  
Mrcc Patient ◽  
First Line Treatment

e18240 Background: There are online tools aimed at helping professionals assess the risks of getting therapy after surgery . Our kidney cancer mobile application (KCMA) has been designed for oncologists to help them decide on the ideal course of treatment of metastatic renal cell carcinoma (mRCC). Here, we present results of comparison of treatment choice of oncologists used KCMA and oncologists made choice based on their knowledge. Methods: KCMA has been developed in 2016. It is strictly built on NCCN guidelines (ver. 3.2016). In our study 122 medical oncologists participated at the RCC meetings were involved. Three clinical cases were proposed. First clinical case described non-treated mRCC patient with favorable MSKCC prognosis (0 unfavorable factors) and clear-cell RCC. Second case described non-treated mRCC patient with poor prognosis (3 factors) and non-clear-cell RCC. Third case characterized patient treated with sunitinib in first-line with progression. 60 and 62 oncologists made treatment choice with (online) or without (offline) mobile application, respectively. Results: Comparison of choice is listed in Table. 100% oncologists used KCMA recommended sunitinib, pazopanib, bevacizumab+IFN or temsirolimus in first-line treatment. 6%, 6% and 12% of offline doctors chose sorafenib, everolimus and axitinib in first-line treatment of clear-cell mRCC. 98.3% of oncologists correctly used application for administration of second-line. 21 of 62 (34%) offline doctors recommended axitinib or everolimus as second-line and 66% prescribed bevacizumab+IFN (31%), sorafenib (15%), pazopanib (4%), temsirolimus (8%) or even continued sunitinib (8%) in patient with disease progression on sunitinib. Conclusions: Online tools based on guidelines could educate and support oncologists to score prognosis and to select best systemic therapy in daily practice. [Table: see text]

KEYNOTE-B61: Open-label phase 2 study of pembrolizumab in combination with lenvatinib as first-line treatment for non-clear cell renal cell carcinoma (nccRCC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS4595-TPS4595
Author(s):  
Chung-Han Lee ◽  
Chenxiang Li ◽  
Rodolfo F. Perini ◽  
Daniela Hoehn ◽  
Laurence Albiges
Keyword(s):  
Safety Profile ◽  
Clear Cell ◽  
Objective Response ◽  
Line Treatment ◽  
Phase 2 ◽  
First Line ◽  
Open Label ◽  
End Points ◽  
Biomarker Analysis ◽  
First Line Treatment

TPS4595 Background: Most RCCs contain clear cell histology; the remainder of cases are summarized as nccRCC. nccRCC is a heterogeneous group of tumors and, with advanced metastases, survival is uniformly worse than with clear cell RCC (ccRCC) because of the aggressiveness of these cancers and a lack of effective systemic treatment options. Because data are limited for patients with nccRCC, the role of various agents in the treatment of nccRCC is poorly defined and there is no standard of care; treatment guidelines recommend clinical trials as preferred strategy. Inhibition of the PD-1/PD-L1 pathway is an effective treatment option for nccRCC, and pembrolizumab monotherapy has shown efficacy with an acceptable safety profile as first-line treatment. The VEGF TKI lenvatinib has also shown efficacy with a tolerable safety profile as combination therapy with everolimus for nccRCC. Also, in the phase 3 KEYNOTE-581 study (NCT02811861), the combination of lenvatinib + pembrolizumab as first-line therapy showed antitumor activity in patients with metastatic ccRCC, suggesting this combination might be an excellent therapeutic option for nccRCC. The phase 2, open-label, single-arm, KEYNOTE-B61 study (NCT04704219) is being conducted to evaluate pembrolizumab in combination with lenvatinib as first-line treatment for nccRCC. Methods: Patients with centrally confirmed nccRCC, locally advanced/metastatic measurable disease per RECIST v1.1 per blinded independent central review (BICR), no prior systemic therapy for nccRCC, and KPS score ≥70 will be enrolled. Approximately 152 patients will receive pembrolizumab 400 mg every 6 weeks and lenvatinib 20 mg once daily. Pembrolizumab treatment will continue for up to approximately 2 years or until a discontinuation criterion is met (disease progression, unacceptable toxicity, or withdrawal of consent); lenvatinib treatment can continue beyond 2 years or until one of the same discontinuation criterion is met. Participants who discontinue one of the treatments can continue to receive the other treatment as monotherapy. A second-course treatment phase is available for patients who meet specific criteria. CT/MRI will be performed at 12 weeks from the start of treatment, every 6 weeks until week 54, and every 12 weeks thereafter. Adverse events will be monitored throughout the study and graded using CTCAE, version 5.0, guidelines. The primary end point is objective response rate based on RECIST v1.1 per BICR. Secondary efficacy end points for this study are clinical benefit rate, disease control rate, duration of response, progression-free survival, overall survival, and safety. Tertiary/exploratory end points are biomarker analysis and association with clinical response/disease etiopathogenesis. Clinical trial information: NCT04704219.

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