Renal Cell Carcinoma   

Questions discussed in this category


Are there specific patients where you're more apt to continue versus holding IO while continuing TKI?

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

Do you typically recommend SBRT? What dose? Or do you ever recommend surgery or surgery followed by XRT?

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?

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

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...

No cord compression is present, and the patient remains symptomatic only with their upper extremity due to brachial plexopathy

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

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

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.

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

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...

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?

If so, how would you design and deliver the treatment?

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?

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

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...

Wouldn't lymph node dissection improve sensitivity of staging and inform adjuvant treatment decisions?

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

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 ...

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...


Papers discussed in this category


Clinical cancer research : an official journal of the American Association for Cancer Research, 2015-02-01

Journal for immunotherapy of cancer, 2015

Cancer immunology, immunotherapy : CII, 2016-08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1995-03

The cancer journal from Scientific American, 2000-02

Cancer immunology, immunotherapy : CII, 2016-12

Urologic oncology, 2015-11

Lancet (London, England), 2016-05-14

The New England journal of medicine, 2016-12-08

JAMA oncology, 2017-09-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-12-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-02-20

International journal of radiation oncology, biology, physics, 2015-06-01

American journal of clinical oncology, 1991-04

Surgery, 2012-12

Annals of surgical oncology, 2018-07

Cancer,

J Clin Endocrinol Metab, 2006 Aug 08

J Cancer Res Ther,

J Clin Endocrinol Metab,

N. Engl. J. Med., 2018 Jun 03

Cancer, 2022 Apr 05

The Lancet. Oncology, 2016-03

European urology, 2016-05

Clinical genitourinary cancer, 2017-12

Journal for immunotherapy of cancer, 2018-01-29

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-11-10

Annals of oncology : official journal of the European Society for Medical Oncology, 2013-04

The New England journal of medicine, 2018-04-05

The New England journal of medicine, 2019-03-21

The Lancet. Oncology, 2015-11

The New England journal of medicine, 2015-11-05

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-02-20

The New England journal of medicine, 2015-11-05

European urology focus, 2019-11

Clinical genitourinary cancer, 2017-02

Journal of immunotherapy (Hagerstown, Md. : 1997), 2014-04

Journal for immunotherapy of cancer, 2019-02-18

Journal of clinical pharmacology, 2010-04

BJU Int, 2011 Oct

Anticancer Drugs,

Cancer, 2010-11-15

Ann Oncol, 2010 Feb 12

N Engl J Med, 2021 Mar 4

JAMA Oncol,

Lancet Oncol, 2020 Jan

N Engl J Med, 2021 Feb 13

J Clin Oncol, 2021 Feb 02

Eur J Cancer, 2020 Jun 27

Eur Urol, 2021 Apr 16

The Lancet. Oncology, 2023 Jul 11

Biomark Insights, 2016 Apr 21

Clin Genitourin Cancer, 2021 Apr 19

Lancet Oncol, 2021 Oct 27

Eur Urol, 2020 Sep 13

Eur Urol Oncol, 2019 Sep 19

N Engl J Med,

Int J Radiat Oncol Biol Phys, 2021 Mar 29

Invest New Drugs, 2017 Oct 25

The New England journal of medicine, 2013-08-22

JAMA oncology, 2016-02

Annals of oncology : official journal of the European Society for Medical Oncology, 2017-02-01

Ann Oncol,

Immunology,

J Immunother Cancer, 2019 Jan 06

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2019-05

J Mol Diagn, 2017 Oct 19

J Clin Oncol, 2022 Mar 17

J Urol,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-10-01

European urology, 2014-09

Lancet (London, England), 2019-06-15

Lancet Oncol, 2019 Jan

Lancet, 2023 Jun 02

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2020 Oct 27

Cancer medicine, 2022 Feb 09

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Apr 20

Clinical genitourinary cancer, 2020 Oct 15

Journal for immunotherapy of cancer, 2023 Mar

Clinical nuclear medicine, 2022 Jan 01

Frontiers in surgery, 2022 Jul 29

European urology open science, 2022 Jan 18

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2019-01

JAMA oncology, 2021 Dec 01

CA: a cancer journal for clinicians, 2022 Jun 16

The Lancet. Oncology, 2016-09

Lancet Oncol, 2020 Oct 23

The Lancet. Oncology, 2022 Jun 07

The Lancet. Oncology, 2023 Mar

JAMA oncology, 2019-06-01

International journal of radiation oncology, biology, physics, 2021 Jan 08

European urology, 2021 Dec 23

Cancer, 2017-06-01

Cancers, 2022 May 17

International journal of urology : official journal of the Japanese Urological Association, 2023 Jun 06

Clinical genitourinary cancer, 2020 Dec 02

JAMA, 2023 Jan 24

British journal of cancer, 2022 Dec 26

Statistical methods in medical research, 2020 Mar 30

Hematology/oncology clinics of North America, 2023 May 25