Chair and Presenters Sumanta Kumar Pal, MD, FASCO, Prof. Laurence Albiges, MD, PhD, and David F. McDermott, MD, prepared useful Practice Aids pertaining to renal cell carcinoma for this CME/MOC/AAPA activity titled “Leveling Up Our RCC Care Strategy: Real-World Translation of Key Evidence Across Treatment Settings.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at https://bit.ly/3LtPuyF. CME/MOC/AAPA credit will be available until December 10, 2024.

1. Managing Immune-Related
Adverse Events1-6
Full abbreviations, accreditation, and disclosure information
available at PeerView.com/DJA40
Monitor closely for potential
irAEs by evaluating blood
work, including liver
enzymes, creatinine, and
thyroid function
Ask patients about
symptoms such as cough,
shortness of breath, and
diarrhea, which may be
signs of pneumonitis or
colitis
Stay in communication with
patients to help mitigate and
treat more common AEs
such as fatigue, nausea, and
anemia
Pancreatitis,
autoimmune diabetes
Colitis
Enteritis
Encephalitis, aseptic meningitis
Thyroiditis, hypothyroidism,
hyperthyroidism
Dry mouth, mucositis
Hypophysitis
Uveitis
Pneumonitis
Thrombocytopenia,
anemia
Hepatitis
Adrenal insufficiency
Nephritis
Vasculitis
Arthralgia
Neuropathy
Rash, vitiligo
Myocarditis
Any organ system can be affected; commonly occurring irAEs are
pulmonary (pneumonitis), dermatologic (rash, pruritus, blisters, ulcers,
vitiligo), gastrointestinal (diarrhea, enterocolitis, transaminitis, hepatitis,
pancreatitis), and endocrine (thyroiditis, hypophysitis,
adrenal insufficiency)
What Is the Spectrum of Potential irAEs?
• In general, checkpoint inhibitor therapy should be continued
with close monitoring, with the exception of some neurologic,
hematologic, and cardiac toxicities
Minimal or no symptoms; diagnostic changes only
Grade 1
• Hold checkpoint inhibitor therapy for most grade 2 toxicities
• Consider resuming immunotherapy when symptoms and/or
laboratory values revert to grade 1 or lower
• Corticosteroids (initial dose of 0.5-1 mg/kg/d of prednisone or
equivalent) may be administered
Grade 3 toxicities
• Hold checkpoint inhibitor therapy
• Initiate high-dose corticosteroids (prednisone 1-2 mg/kg/d or
methylprednisolone IV 1-2 mg/kg/d)
• If symptoms do not improve with 48-72 hours of high-dose
corticosteroids, infliximab may be offered for some toxicities
• Taper corticosteroids over the course of at least 4-6 weeks
• When symptoms and/or laboratory values revert to grade 1 or lower,
rechallenging with immunotherapy may be offered; however, caution
is advised, especially in those patients with early-onset irAEs; dose
adjustments are not recommended
Grade 4 toxicities
• In general, permanent discontinuation of checkpoint inhibitor
therapy is warranted, with the exception of endocrinopathies that
have been controlled by hormone replacement
Grade 2
Mild to moderate symptoms
Severe or life-threatening symptoms
Grades 3/4
irAE Grading and Management
Safety Considerations
for Immunotherapies

2. Managing Immune-Related
Adverse Events1-6
Full abbreviations, accreditation, and disclosure information
available at PeerView.com/DJA40
Consult irAE management guidelines
(eg, ASCO, NCCN, SITC, ESMO)
IO
Pruritus
Pneumonitis
Myocarditis
Adrenal crisis
TKI
Hypertension
Taste changes
Stomatitis
Dyspepsia
Cytopenia
HFSR
Overlapping
Rash
Diarrhea
Hepatitis
Hypothyroid
AMS
IO + TKI Combination Toxicities
Determine which therapy is causing the AE
in order to plan a management strategy
Hold TKI (shorter half-life than checkpoint inhibitor)
In certain cases, use appropriate supportive care
If symptoms resolve in a few days, TKI was likely the cause
Two mechanisms of action result in two sets of
AE profiles that are not mutually exclusive
PRES
Encephalitis
1. Postow MA et al. N Engl J Med. 2018;378:158-168. 2. Schneider BJ et al. J Clin Oncol. 2021;39:4073-4126. 3. NCCN Clinical Practice Guidelines in Oncology. Management of Immunotherapy-Related
Toxicities. Version 3.2023. https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf. 4. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm.
5. Naidoo J et al. J Immunother Cancer. 2023;11:e006398. 6. Haanen J et al. Ann Oncol. 2022;33:1217-1238.

3. Patient Education:
Understanding Renal Cell Carcinoma Treatment Options
Full abbreviations, accreditation, and disclosure information available at PeerView.com/DJA40
Receiving a diagnosis of renal cell carcinoma (RCC) can be
overwhelming for patients and their caregivers. Please use the
following one-page, printable resource to help your patients and
their caregivers understand RCC treatment options and where
they can turn for more support.
Printable Resource

4. Understanding Kidney Cancer: A Quick Reference for Patients
If you or someone you love has been diagnosed with the most common form of kidney cancer—
renal cell carcinoma or RCC—you may have a lot of questions about treatment options and where you can turn for help.
What are the different kinds of RCC?
There are a variety of kidney cancers; the most common form of cancer found in the kidney
is renal cell carcinoma (RCC), which accounts for 85% of kidney tumors. Within RCC,
there are different subtypes, the most common of which is clear cell. Non–clear cell RCC
includes papillary and chromophobe subtypes.
What do staging and grading refer to, and what do they mean for treatment?
• Kidney cancer is staged—or classified—by the size of the tumor and whether it has
spread beyond the original tumor; stage 1 tumors are small and localized, while stage 4
tumors have spread to nearby and possibly distant organs and lymph nodes.
• Cancer grading refers to how aggressive the cells look under a microscope and also
uses a 1 to 4 scale, with 1 being the least and 4 the most aggressive.
Staging and grading provide the treatment team with information on how
quickly a cancer is expected to grow and how likely it is to recur. The patient and
cancer care team will consider these factors when choosing a treatment plan.
What treatments are available?
Patients with small tumors that have not spread to other parts of the body may be treated
with surgery or, in some cases, radiation. Patients with more advanced kidney cancer
that has spread beyond the kidney may require immunotherapy, which is a treatment
that uses a person’s own immune system to fight cancer; targeted therapies, which
target specific changes in a cancer cell to block its growth and spread; or combinations
of immunotherapy and/or targeted agents.
Your team will let you know what to expect from each treatment, including
how the medicine is given, which side effects are common, and how the medication
may affect your lifestyle, so you and your team can choose a treatment
plan that best fits your needs.
What side effects are associated with kidney cancer treatments?
Side effects vary by treatment, and not all patients have the same experience with each
agent. Patients receiving immunotherapy or targeted therapies may experience diarrhea,
rashes, fatigue, and other issues, depending on the particular treatment.
If you think you may be experiencing a side effect, it is important to let your cancer
care team know right away. Your provider may adjust or change your treatment, as
the goal is for you to receive treatment as long as possible to achieve optimal
results while maintaining your quality of life.
Spotlight on Clinical Trials
Your cancer care team may offer you the option of enrolling
in a clinical trial. These studies provide important information
on whether a treatment is safe and effective and give you
access to new strategies that could be better than the
options currently used.
Clinical trial enrollment is voluntary. Each trial has
specific enrollment criteria (eg, age, type of cancer,
stage, prior treatments). Talk to your cancer care team
about whether clinical trial enrollment
is right for you.
Where Can You Get More Support?
Online and in-person advocacy foundations for patients and
their caregivers provide a variety of services, including
support groups, counseling, financial assistance, information
on treatments and clinical trials, opportunities to support and
participate in research, and educational workshops.
 Action to Cure Kidney Cancer: ackc.org
 American Cancer Society: cancer.org
 CancerCare: cancercare.org/support_groups/137-
kidney_cancer_patient_support_group
 International Kidney Cancer Coalition: ikcc.org
 KCCure: kccure.org
 Kidney Cancer Association: kidneycancer.org
 KidneyCAN: kidneycan.org
Visit the links below to learn more about the resources
each organization offers.
What You Need to Know About Kidney Cancer Treatment