Renal Cell Carcinoma   

KEYNOTE-564 required CrCl 30 or above. Not having a baseline/stable CrCl may make it difficult to diagnose or treat IO nephritis. 

How are you incorporating CONTACT-03 data presented at #ASCO2023 (Pal et al., PMID 37290461) into your practice? Would you consider immunotherapy re-c...

Assume the patient is not a candidate for surgery. What dose would you use? Would you recommend a lower dose to not damage the patient's kidney functi...

Would you consider using an IO-based treatment or move on to TKI? Does the presence of sarcomatoid or rhabdoid features impact your approach?

Would you avoid combination with TKI given possible higher risk of osteonecrosis of the jaw?

Any role for adjuvant therapy? If so, with what agent?

For example, in a patient on steroids for CNS or spinal metastases - would you use IO-IO vs IO-TKI or TKI monotherapy?

Any data to support this combination for non-clear cell RCC?

Would you treat with adjuvant chemotherapy or immunotherapy?

Would you consider re-challenging with a different TKI?

Is Crohn's diagnosis an absolute contraindication for immunotherapy?

Do you observe, offer adjuvant pembrolizumab, or give a first-line metastatic regimen (IO/IO or IO/TKI)? Does your recommendation vary based on risk c...

How do you weigh the various efficacy endpoints in the trials of novel combinations in ccRCC?  Are there specific clinical populations that you ...

How would need for anticoagulation change your consideration?

Does disease response (CR vs PR vs SD) or IO-TKI combination factor into your consideration?

When is the optimal time (if ever) for cytoreductive nephrectomy?

Or with other available IO/TKI combinations should this be strictly reserved for intermediate/high risk patients only?  If selecting IO/TKI, do ...

Or what is your preferred regimen for stage IV ccRCC following progression on IO/IO?

Do you select treatment based on toxicity profile since efficacy of regimens will likely never be directly compared? Are there QOL indices that can ...

Patient has progression of liver metastases while on pembrolzumab/axitinib. ECOG PS 1 and limited comorbidities.

Would active vasculitis present a contraindication to therapy?

Is DFS benefit in KN-564 in ASCO2021 sufficient evidence to change practice?

MiT subfamily translocations = TFE3, TFEB, TFC, or MiTF

Given antiangiogenic activity, is any TKI an option? 

Any special precautions needed?

In this case, nivo/ipi discontinued for immune-related arthralgias requiring steroids and an anti-TNFa agent, now off all immunosuppression.

There was an abstract in European J of Cancer (Srinivasan R, 2014:50: S6, P8) showing a good response rate with Bevacizumab and Erlotinib. Would you u...

Is the short time to recurrence a reason to not consider definitive management with surgery/radiation? Should systemic therapy be added if pursuing d...

Would you offer for T2N0 G3 resected disease with LVI?

For patients who have progressed on first line checkpoint inhibitor (e.g. Nivo/Ipi) and second line TKI (e.g. Cabozantinib) 

What systemic therapy options are available for ESRD patients?

For example, is there any data to suggest a benefit to starting with immunotherapy prior to TKI or the alternative?

Is there any specific precautions or concerns to consider with TKI initiation if the patient has vasogenic edema?

Would you do systemic treatment or observe? 

(assuming that the patient is int-poor risk, has measurable disease outside of the CNS, warrants treatment with appropriate PS)

Patient has MSKCC high risk disease. Immunosuppression is with mycophenolate mofetil and tacrolimus.

Is this also a marker of TKI sensitivity?

Does the extent of the surgery matter? 

NCCN include active surveillance as an option in specific circumstances based on Rini et al. (Lancet Oncology 2016) however this set is not well defin...

Would you treat until progression or for a defined "adjuvant" course after nephrectomy?

Are there any patient and/or pathologic features that would lend you to considering IL-2 over other approved I/O or TKI therapies?

Would you consider treatment based upon imaging alone or would you wait for tissue confirmation of metastatic disease?

Most of the studies have excluded non clear cell histologies. If you use a similar approach to clear cell, have you seen similar responses?

What are the special considerations in the non-metastatic setting vs metastatic setting?

Recent evidence has been mixed, with no DFS or OS benefit in 1 trial (ASSURE, Haas et al, Lancet 2016) and DFS benefit in another (S-TRAC, Ravaud et a...

The CABOSUN trial showed a benefit in PFS and ORR, with unchanged OS, over sunitinib. 

In the setting of recent craniotomy and a plan for SRS to the surgical cavity, which systemic therapy would you choose and when would you start it?

For patients who developed oligometastases while off systemic treatment, do you start systemic therapy following local therapy or return to active sur...

Are there circumstances when you would choose IL-2 over checkpoint inhibitor trials or TKIs for fit patients? How should IL-2 be sequenced with these ...

How has CARMENA changed your practice?

For patients who remain fit and interested in treatment, but for whom a clinical trial is not an option, what systemic therapy do you reach for in thi...