SlideShare a Scribd company logo
1 of 4
Download to read offline
Access the activity, “Finding the Path to Clinically Meaningful Outcomes Among
Expanding Treatment Options in Renal Cell Carcinoma,” at PeerView.com/KSB40
IMDC: International Metastatic Renal Cell Carcinoma Database Consortium; LLN: lower limit of normal; mOS: median overall survival; MSKCC: Memorial Sloan Kettering Cancer Center;
RCC: renal cell carcinoma; ULN: upper limit of normal.
1. https://www.mdcalc.com. 2. Heng DY et al. J Clin Oncol. 2009;27:5794-5799. 3. Motzer RJ et al. J Clin Oncol. 2002;20:289-296. 4. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer.
Version 2.2020. https://www.nccn.org/professionals/physician_gls/PDF/kidney.pdf.
PRACTICE AID
Criteria for Evaluating Risk
in RCC: Risk Calculators1-4
Guidance From IMDC and MSKCC: Know Your Risk
IMDC Risk Model
for Metastatic RCC
MSKCC Risk Model
for Metastatic RCC
Prognostic Factor Yes No
Diagnosis to systemic treatment
interval <1 y
£ £
Karnofsky Performance Status
<80%
£ £
Hemoglobin <LLN
(Normal: 120 g/L or 12 g/dL)
£ £
Corrected serum calcium >ULN
(Normal: 8.5-10.2 mg/dL)
£ £
Neutrophils >ULN
(Normal: 2.0-7.0 x 109
/L)
£ £
Platelets >ULN
(Normal: 150,000-400,000 cells/mcL)
£ £
No. of Factors Risk Group mOS
0 Favorable 43.2 mo
1-2 Intermediate 22.5 mo
3-6 Poor 7.8 mo
No. of Factors Risk Group mOS
0 Favorable 20 mo
1-2 Intermediate 10 mo
3-5 Poor 4 mo
Prognostic Factor Yes No
Diagnosis to systemic treatment
interval <1 y
£ £
Karnofsky Performance Status
<80%
£ £
Hemoglobin <LLN
(Normal, men: 13.5-17.5 g/dL;
women: 12.0-15.5 g/dL)
£ £
Corrected serum calcium
>10 mg/dL
£ £
Lactate dehydrogenase x
ULN >1.5
(Normal: 140 U/L)
£ £
Calculating risk score is important
for treatment decisions; multiple risk
criteria are available
Access the activity, “Finding the Path to Clinically Meaningful Outcomes Among
Expanding Treatment Options in Renal Cell Carcinoma,” at PeerView.com/KSB40
1. https://kccure.org/. 2. https://clinicaltrials.gov/ct2/show/NCT03141177. 3. https://www.urotoday.com/recent-abstracts/urologic-oncology/renal-cancer/120904-phase-3-checkmate-9er-trial-
evaluating-opdivo-nivolumab-in-combination-with-cabometyx-cabozantinib-in-previously-untreated-advanced-renal-cell-carcinoma-demonstrates-positive-results.html.
PRACTICE AID
Kidney Cancer Resources for
Patients and Caregivers
Kidney Cancer Treatment Options
Have you been diagnosed with metastatic
or advanced kidney cancer? The US FDA has
approved 14 therapies for the treatment of
metastatic kidney cancer and one adjuvant
therapy for high-risk localized kidney cancer
following surgery. The following table lists
the three combinations approved for
advanced kidney cancer treatment in the
frontline setting; please see this section of
the website for information on all 14 options.
Kidney Cancer Types
This page describes the different
types of kidney cancer. The most
common form of cancer found in
the kidney is renal cell carcinoma
(RCC), but there are different
subtypes. A pathologist identifies
these subtypes or histologies by
looking at your tumor tissue under a microscope
following surgery or a biopsy. Knowing your
subtype is important because it could impact
decisions about surveillance and treatment.
Generic
Names
How It
Works
FDA
Approval
Mainly
Used
Ipilimumab +
nivolumab
Dual
immunotherapy:
anti–CTLA-4
inhibitor/
anti–PD-1
checkpoint inhibitor;
infusion
In 2018, for
intermediate-
and high-risk
metastatic
RCC
1st
line
Pembrolizumab
+ axitinib
Immunotherapy
(anti–PD-1
checkpointinhibitor)
+ targeted therapy
(tyrosine kinase
inhibitor); infusion
and oral
In 2019,
for metastatic
RCC
1st
line
Avelumab +
axitinib
Immunotherapy
(anti–PD-L1
checkpointinhibitor)
+ targeted therapy
(tyrosine kinase
inhibitor); infusion
and oral
In 2019,
for metastatic
RCC
1st
line
The Kidney Cancer Research Alliance (KCCure)1
provides answers to questions that patients and caregivers are asking.
Wherever they are in their diagnosis, patients can visit kccure.org to find updated information on different types of kidney
cancer, new treatment options, and more.
Clear cell
Translocation
Collectingduct
~70% of RCC
3-4% of RCC
<3% of RCC
Papillary
Unclassified
Clearcellpapillary
~10-15% of RCC
3-4% of RCC
<3% of RCC
Chromophobe
Renal medullary
Cystic
~5% of RCC
Rare
2.5% of RCC
Stay
Up to
Date!
CheckMate -9ER2,3
(cabozantinib + nivolumab)
reported positive results;
data will be out soon.
CHECKMATE-214KEYNOTE-426JAVELIN101
Access the activity, “Finding the Path to Clinically Meaningful Outcomes Among
Expanding Treatment Options in Renal Cell Carcinoma,” at PeerView.com/KSB40
PRACTICE AID
Guide to Managing Adverse
Events Associated With Immune
Checkpoint Inhibitors and TKIs1,2
• 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
Immune checkpoint inhibitors are associated with important
clinical benefits, but general immunologic enhancement can also
lead to a unique spectrum of immune-related adverse events (irAEs)
irAEs are often diagnosed by
exclusion; other causes should
be ruled out (including AEs of
other therapies used), but
immunotherapy-related
toxicity should always be
included in the differential
There should be a high level of
suspicion that new symptoms
are treatment related; early
recognition, evaluation, and
treatment of irAEs plus patient
education are essential for best
outcome
Depending on severity of
irAEs, management may
require corticosteroid or other
immunosuppressive
treatment as well as
interruption or
discontinuation of therapy
If appropriate,
immunosuppressive treatment
is used; patients generally
recover from irAEs
How should irAEs be diagnosed
and managed?
What are the general recommendations
for management?
What is the spectrum of potential irAEs?
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 are pulmonary
(pneumonitis), dermatologic (rash, pruritus, blisters, ulcers, vitiligo),
gastrointestinal (diarrhea, enterocolitis, transaminitis, hepatitis, pancreatitis),
and endocrine (thyroiditis, hypophysitis, adrenal insufficiency) irAEsWhy do
irAEs occur?
“Taking the brakes off”
of the immune system can
help the body fight cancer,
but it can also lead to toxicity
from a“supercharged”
immune system.
Access the activity, “Finding the Path to Clinically Meaningful Outcomes Among
Expanding Treatment Options in Renal Cell Carcinoma,” at PeerView.com/KSB40
PRACTICE AID
Guide to Managing Adverse
Events Associated With Immune
Checkpoint Inhibitors and TKIs1,2
ADL: activities of daily living; AMS: altered mental status; HFSR: hand–foot skin reaction; IO: immunotherapy; irAE: immune-related adverse event; PRES: posterior reversible encephalopathy
syndrome; TKI: tyrosine kinase inhibitors.
1. Postow MA et al. N Engl J Med. 2018;378:158-168. 2. Brahmer JR et al. J Clin Oncol. 2018;36:1714-1768. 3. Walko CM et al. Semin Oncol. 2014;41(suppl 2):s17-s28. 4. CTCAE version 5.0.
https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_50. 5. McLellan B et al. Ann Oncol. 2015;26:2017-2026. 6. Brose MS et al. Semin Oncol. 2014;41(suppl 2):s1-s16.
7. Lacouture ME et al. Oncologist. 2008;13:1001-1011. 8. https://www.urotoday.com/conference-highlights/asco-gu-2020/asco-gu-2020-kidney-cancer/119282-asco-gu-2020-toxicity-profiles-
and-side-effect-management-of-first-line-treatment-options-of-renal-cell-carcinoma.html.
Common adverse events associated with TKIs include
diarrhea, fatigue, and hand−foot skin reaction3,4
 Monitor bowel habits, and report any increase
in activity above normal
 Avoid spicy or fatty foods; plain, simple foods
are best
 Avoid fruit and caffeine
 Maintain adequate fluid intake to avoid
dehydration
 Monitor/manage electrolytes
 Loperamide is usually effective
 If loperamide is ineffective, consider
diphenoxylate/atropine
Diarrhea4
Hand–Foot Skin Reaction5-7
For frequent, watery, bloody, or nocturnal stools,
or any diarrhea or abdominal distress, patients
should notify medical team immediately.
Fatigue4
IO + TKI Combination Toxicities8
Educating your patients on managing fatigue
is essential.
Be aware of overlapping toxicities that can occur
with IO + TKI combination therapy.
Patient Education
 Staying as active as possible helps regulate sleep
 Maintain a normal work and social schedule
 Take breaks as needed
 Tell your medical team if activity is intolerable or
fatigue worsens
 Erythema with or without blisters;
hyperkeratotic lesions on palms and soles
 Commonly accompanied by dysesthesia
(burning, pain, tingling)
 Perform full-body skin examination, focusing
on deformities and hyperkeratotic areas on
palms and soles, before treatment initiation
 Have patients remove their shoes and examine
their feet during each visit
 Recommend podiatrist evaluation (can help with
removal of calluses and hyperkeratotic regions)
and orthotist evaluation and use of orthotic
devices in patients with abnormal weight bearing
 During early therapy (2-4 wk), encourage rest
and avoidance of vigorous exercise and
traumatic activity
Medical Intervention
General Management
Symptoms
Prophylaxis
Immunotherapy VEGF TKI
Pruritus
Pneumonitis
Myocarditis
Adrenal crisis
Hypertension
Taste changes
Stomatitis
Dyspepsia
Cytopenias
HFSR
Rash
Diarrhea
Hepatitis
Hypothyroid
AMS
Encephalitis PRES

More Related Content

More from PVI, PeerView Institute for Medical Education

Reinforcing the “Bridge” to HCT in AML: Clinical Conversations on Augmenting ...
Reinforcing the “Bridge” to HCT in AML: Clinical Conversations on Augmenting ...Reinforcing the “Bridge” to HCT in AML: Clinical Conversations on Augmenting ...
Reinforcing the “Bridge” to HCT in AML: Clinical Conversations on Augmenting ...PVI, PeerView Institute for Medical Education
 

More from PVI, PeerView Institute for Medical Education (20)

Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Po...
Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Po...Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Po...
Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Po...
 
Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Po...
Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Po...Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Po...
Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Po...
 
Advancing ADCs in Gynecologic Cancers: Expert Insights on Recent Evidence, Im...
Advancing ADCs in Gynecologic Cancers: Expert Insights on Recent Evidence, Im...Advancing ADCs in Gynecologic Cancers: Expert Insights on Recent Evidence, Im...
Advancing ADCs in Gynecologic Cancers: Expert Insights on Recent Evidence, Im...
 
Screening and Early Intervention as the Keys to Success in Lung Cancer: A Pra...
Screening and Early Intervention as the Keys to Success in Lung Cancer: A Pra...Screening and Early Intervention as the Keys to Success in Lung Cancer: A Pra...
Screening and Early Intervention as the Keys to Success in Lung Cancer: A Pra...
 
Screening and Early Intervention as the Keys to Success in Lung Cancer: A Pra...
Screening and Early Intervention as the Keys to Success in Lung Cancer: A Pra...Screening and Early Intervention as the Keys to Success in Lung Cancer: A Pra...
Screening and Early Intervention as the Keys to Success in Lung Cancer: A Pra...
 
Democratizing the CAR-T Experience: The Principles and Practice of Outpatient...
Democratizing the CAR-T Experience: The Principles and Practice of Outpatient...Democratizing the CAR-T Experience: The Principles and Practice of Outpatient...
Democratizing the CAR-T Experience: The Principles and Practice of Outpatient...
 
Democratizing the CAR-T Experience: The Principles and Practice of Outpatient...
Democratizing the CAR-T Experience: The Principles and Practice of Outpatient...Democratizing the CAR-T Experience: The Principles and Practice of Outpatient...
Democratizing the CAR-T Experience: The Principles and Practice of Outpatient...
 
The Convergence of Interventional Radiologists and Oncologists in HCC: Shared...
The Convergence of Interventional Radiologists and Oncologists in HCC: Shared...The Convergence of Interventional Radiologists and Oncologists in HCC: Shared...
The Convergence of Interventional Radiologists and Oncologists in HCC: Shared...
 
Navigating Narcolepsy in Family Practice: Patient-Centered Strategies to Opti...
Navigating Narcolepsy in Family Practice: Patient-Centered Strategies to Opti...Navigating Narcolepsy in Family Practice: Patient-Centered Strategies to Opti...
Navigating Narcolepsy in Family Practice: Patient-Centered Strategies to Opti...
 
New Chapters in the Immunotherapy Story for Melanoma: Collaborative Care and ...
New Chapters in the Immunotherapy Story for Melanoma: Collaborative Care and ...New Chapters in the Immunotherapy Story for Melanoma: Collaborative Care and ...
New Chapters in the Immunotherapy Story for Melanoma: Collaborative Care and ...
 
Unraveling the Complex Choices in Early Breast Cancer: A Roadmap to Informed ...
Unraveling the Complex Choices in Early Breast Cancer: A Roadmap to Informed ...Unraveling the Complex Choices in Early Breast Cancer: A Roadmap to Informed ...
Unraveling the Complex Choices in Early Breast Cancer: A Roadmap to Informed ...
 
From Resistance to Resilience in R/R CLL: Sequencing Strategies for Achieving...
From Resistance to Resilience in R/R CLL: Sequencing Strategies for Achieving...From Resistance to Resilience in R/R CLL: Sequencing Strategies for Achieving...
From Resistance to Resilience in R/R CLL: Sequencing Strategies for Achieving...
 
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
 
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
 
The A-Team Against Relapsed/Refractory Myeloma: Community Strategies for Enha...
The A-Team Against Relapsed/Refractory Myeloma: Community Strategies for Enha...The A-Team Against Relapsed/Refractory Myeloma: Community Strategies for Enha...
The A-Team Against Relapsed/Refractory Myeloma: Community Strategies for Enha...
 
Finite Therapy, Infinite Possibilities in CLL: Exploring the Rapid Emergence ...
Finite Therapy, Infinite Possibilities in CLL: Exploring the Rapid Emergence ...Finite Therapy, Infinite Possibilities in CLL: Exploring the Rapid Emergence ...
Finite Therapy, Infinite Possibilities in CLL: Exploring the Rapid Emergence ...
 
Advancing Patient Care in Chronic Spontaneous Urticaria: Reshaping the Future...
Advancing Patient Care in Chronic Spontaneous Urticaria: Reshaping the Future...Advancing Patient Care in Chronic Spontaneous Urticaria: Reshaping the Future...
Advancing Patient Care in Chronic Spontaneous Urticaria: Reshaping the Future...
 
Conversations With Peers About T2DM: Best Practices for Optimizing Treatment ...
Conversations With Peers About T2DM: Best Practices for Optimizing Treatment ...Conversations With Peers About T2DM: Best Practices for Optimizing Treatment ...
Conversations With Peers About T2DM: Best Practices for Optimizing Treatment ...
 
Cases in the Community: Optimizing Treatment and Considering Weight Managemen...
Cases in the Community: Optimizing Treatment and Considering Weight Managemen...Cases in the Community: Optimizing Treatment and Considering Weight Managemen...
Cases in the Community: Optimizing Treatment and Considering Weight Managemen...
 
Reinforcing the “Bridge” to HCT in AML: Clinical Conversations on Augmenting ...
Reinforcing the “Bridge” to HCT in AML: Clinical Conversations on Augmenting ...Reinforcing the “Bridge” to HCT in AML: Clinical Conversations on Augmenting ...
Reinforcing the “Bridge” to HCT in AML: Clinical Conversations on Augmenting ...
 

Recently uploaded

Bangalore Call Girls Hebbal Kempapura Number 7001035870 Meetin With Bangalor...
Bangalore Call Girls Hebbal Kempapura Number 7001035870  Meetin With Bangalor...Bangalore Call Girls Hebbal Kempapura Number 7001035870  Meetin With Bangalor...
Bangalore Call Girls Hebbal Kempapura Number 7001035870 Meetin With Bangalor...narwatsonia7
 
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...Neha Kaur
 
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...Taniya Sharma
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...CALL GIRLS
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Dipal Arora
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...narwatsonia7
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...chandars293
 
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...narwatsonia7
 
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...narwatsonia7
 
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipurparulsinha
 
Chandrapur Call girls 8617370543 Provides all area service COD available
Chandrapur Call girls 8617370543 Provides all area service COD availableChandrapur Call girls 8617370543 Provides all area service COD available
Chandrapur Call girls 8617370543 Provides all area service COD availableDipal Arora
 
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsBangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsGfnyt
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiLow Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiSuhani Kapoor
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...Taniya Sharma
 
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Colaba Mumbai ❤️ 9920874524 👈 Cash on Delivery
Call Girls Colaba Mumbai ❤️ 9920874524 👈 Cash on DeliveryCall Girls Colaba Mumbai ❤️ 9920874524 👈 Cash on Delivery
Call Girls Colaba Mumbai ❤️ 9920874524 👈 Cash on Deliverynehamumbai
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 

Recently uploaded (20)

Bangalore Call Girls Hebbal Kempapura Number 7001035870 Meetin With Bangalor...
Bangalore Call Girls Hebbal Kempapura Number 7001035870  Meetin With Bangalor...Bangalore Call Girls Hebbal Kempapura Number 7001035870  Meetin With Bangalor...
Bangalore Call Girls Hebbal Kempapura Number 7001035870 Meetin With Bangalor...
 
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
 
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
 
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
 
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
 
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
 
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
 
Chandrapur Call girls 8617370543 Provides all area service COD available
Chandrapur Call girls 8617370543 Provides all area service COD availableChandrapur Call girls 8617370543 Provides all area service COD available
Chandrapur Call girls 8617370543 Provides all area service COD available
 
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsBangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
 
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiLow Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
 
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
 
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Colaba Mumbai ❤️ 9920874524 👈 Cash on Delivery
Call Girls Colaba Mumbai ❤️ 9920874524 👈 Cash on DeliveryCall Girls Colaba Mumbai ❤️ 9920874524 👈 Cash on Delivery
Call Girls Colaba Mumbai ❤️ 9920874524 👈 Cash on Delivery
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
 

Finding the Path to Clinically Meaningful Outcomes Among Expanding Treatment Options in Renal Cell Carcinoma

  • 1. Access the activity, “Finding the Path to Clinically Meaningful Outcomes Among Expanding Treatment Options in Renal Cell Carcinoma,” at PeerView.com/KSB40 IMDC: International Metastatic Renal Cell Carcinoma Database Consortium; LLN: lower limit of normal; mOS: median overall survival; MSKCC: Memorial Sloan Kettering Cancer Center; RCC: renal cell carcinoma; ULN: upper limit of normal. 1. https://www.mdcalc.com. 2. Heng DY et al. J Clin Oncol. 2009;27:5794-5799. 3. Motzer RJ et al. J Clin Oncol. 2002;20:289-296. 4. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer. Version 2.2020. https://www.nccn.org/professionals/physician_gls/PDF/kidney.pdf. PRACTICE AID Criteria for Evaluating Risk in RCC: Risk Calculators1-4 Guidance From IMDC and MSKCC: Know Your Risk IMDC Risk Model for Metastatic RCC MSKCC Risk Model for Metastatic RCC Prognostic Factor Yes No Diagnosis to systemic treatment interval <1 y £ £ Karnofsky Performance Status <80% £ £ Hemoglobin <LLN (Normal: 120 g/L or 12 g/dL) £ £ Corrected serum calcium >ULN (Normal: 8.5-10.2 mg/dL) £ £ Neutrophils >ULN (Normal: 2.0-7.0 x 109 /L) £ £ Platelets >ULN (Normal: 150,000-400,000 cells/mcL) £ £ No. of Factors Risk Group mOS 0 Favorable 43.2 mo 1-2 Intermediate 22.5 mo 3-6 Poor 7.8 mo No. of Factors Risk Group mOS 0 Favorable 20 mo 1-2 Intermediate 10 mo 3-5 Poor 4 mo Prognostic Factor Yes No Diagnosis to systemic treatment interval <1 y £ £ Karnofsky Performance Status <80% £ £ Hemoglobin <LLN (Normal, men: 13.5-17.5 g/dL; women: 12.0-15.5 g/dL) £ £ Corrected serum calcium >10 mg/dL £ £ Lactate dehydrogenase x ULN >1.5 (Normal: 140 U/L) £ £ Calculating risk score is important for treatment decisions; multiple risk criteria are available
  • 2. Access the activity, “Finding the Path to Clinically Meaningful Outcomes Among Expanding Treatment Options in Renal Cell Carcinoma,” at PeerView.com/KSB40 1. https://kccure.org/. 2. https://clinicaltrials.gov/ct2/show/NCT03141177. 3. https://www.urotoday.com/recent-abstracts/urologic-oncology/renal-cancer/120904-phase-3-checkmate-9er-trial- evaluating-opdivo-nivolumab-in-combination-with-cabometyx-cabozantinib-in-previously-untreated-advanced-renal-cell-carcinoma-demonstrates-positive-results.html. PRACTICE AID Kidney Cancer Resources for Patients and Caregivers Kidney Cancer Treatment Options Have you been diagnosed with metastatic or advanced kidney cancer? The US FDA has approved 14 therapies for the treatment of metastatic kidney cancer and one adjuvant therapy for high-risk localized kidney cancer following surgery. The following table lists the three combinations approved for advanced kidney cancer treatment in the frontline setting; please see this section of the website for information on all 14 options. Kidney Cancer Types This page describes the different types of kidney cancer. The most common form of cancer found in the kidney is renal cell carcinoma (RCC), but there are different subtypes. A pathologist identifies these subtypes or histologies by looking at your tumor tissue under a microscope following surgery or a biopsy. Knowing your subtype is important because it could impact decisions about surveillance and treatment. Generic Names How It Works FDA Approval Mainly Used Ipilimumab + nivolumab Dual immunotherapy: anti–CTLA-4 inhibitor/ anti–PD-1 checkpoint inhibitor; infusion In 2018, for intermediate- and high-risk metastatic RCC 1st line Pembrolizumab + axitinib Immunotherapy (anti–PD-1 checkpointinhibitor) + targeted therapy (tyrosine kinase inhibitor); infusion and oral In 2019, for metastatic RCC 1st line Avelumab + axitinib Immunotherapy (anti–PD-L1 checkpointinhibitor) + targeted therapy (tyrosine kinase inhibitor); infusion and oral In 2019, for metastatic RCC 1st line The Kidney Cancer Research Alliance (KCCure)1 provides answers to questions that patients and caregivers are asking. Wherever they are in their diagnosis, patients can visit kccure.org to find updated information on different types of kidney cancer, new treatment options, and more. Clear cell Translocation Collectingduct ~70% of RCC 3-4% of RCC <3% of RCC Papillary Unclassified Clearcellpapillary ~10-15% of RCC 3-4% of RCC <3% of RCC Chromophobe Renal medullary Cystic ~5% of RCC Rare 2.5% of RCC Stay Up to Date! CheckMate -9ER2,3 (cabozantinib + nivolumab) reported positive results; data will be out soon. CHECKMATE-214KEYNOTE-426JAVELIN101
  • 3. Access the activity, “Finding the Path to Clinically Meaningful Outcomes Among Expanding Treatment Options in Renal Cell Carcinoma,” at PeerView.com/KSB40 PRACTICE AID Guide to Managing Adverse Events Associated With Immune Checkpoint Inhibitors and TKIs1,2 • 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 Immune checkpoint inhibitors are associated with important clinical benefits, but general immunologic enhancement can also lead to a unique spectrum of immune-related adverse events (irAEs) irAEs are often diagnosed by exclusion; other causes should be ruled out (including AEs of other therapies used), but immunotherapy-related toxicity should always be included in the differential There should be a high level of suspicion that new symptoms are treatment related; early recognition, evaluation, and treatment of irAEs plus patient education are essential for best outcome Depending on severity of irAEs, management may require corticosteroid or other immunosuppressive treatment as well as interruption or discontinuation of therapy If appropriate, immunosuppressive treatment is used; patients generally recover from irAEs How should irAEs be diagnosed and managed? What are the general recommendations for management? What is the spectrum of potential irAEs? 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 are pulmonary (pneumonitis), dermatologic (rash, pruritus, blisters, ulcers, vitiligo), gastrointestinal (diarrhea, enterocolitis, transaminitis, hepatitis, pancreatitis), and endocrine (thyroiditis, hypophysitis, adrenal insufficiency) irAEsWhy do irAEs occur? “Taking the brakes off” of the immune system can help the body fight cancer, but it can also lead to toxicity from a“supercharged” immune system.
  • 4. Access the activity, “Finding the Path to Clinically Meaningful Outcomes Among Expanding Treatment Options in Renal Cell Carcinoma,” at PeerView.com/KSB40 PRACTICE AID Guide to Managing Adverse Events Associated With Immune Checkpoint Inhibitors and TKIs1,2 ADL: activities of daily living; AMS: altered mental status; HFSR: hand–foot skin reaction; IO: immunotherapy; irAE: immune-related adverse event; PRES: posterior reversible encephalopathy syndrome; TKI: tyrosine kinase inhibitors. 1. Postow MA et al. N Engl J Med. 2018;378:158-168. 2. Brahmer JR et al. J Clin Oncol. 2018;36:1714-1768. 3. Walko CM et al. Semin Oncol. 2014;41(suppl 2):s17-s28. 4. CTCAE version 5.0. https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_50. 5. McLellan B et al. Ann Oncol. 2015;26:2017-2026. 6. Brose MS et al. Semin Oncol. 2014;41(suppl 2):s1-s16. 7. Lacouture ME et al. Oncologist. 2008;13:1001-1011. 8. https://www.urotoday.com/conference-highlights/asco-gu-2020/asco-gu-2020-kidney-cancer/119282-asco-gu-2020-toxicity-profiles- and-side-effect-management-of-first-line-treatment-options-of-renal-cell-carcinoma.html. Common adverse events associated with TKIs include diarrhea, fatigue, and hand−foot skin reaction3,4  Monitor bowel habits, and report any increase in activity above normal  Avoid spicy or fatty foods; plain, simple foods are best  Avoid fruit and caffeine  Maintain adequate fluid intake to avoid dehydration  Monitor/manage electrolytes  Loperamide is usually effective  If loperamide is ineffective, consider diphenoxylate/atropine Diarrhea4 Hand–Foot Skin Reaction5-7 For frequent, watery, bloody, or nocturnal stools, or any diarrhea or abdominal distress, patients should notify medical team immediately. Fatigue4 IO + TKI Combination Toxicities8 Educating your patients on managing fatigue is essential. Be aware of overlapping toxicities that can occur with IO + TKI combination therapy. Patient Education  Staying as active as possible helps regulate sleep  Maintain a normal work and social schedule  Take breaks as needed  Tell your medical team if activity is intolerable or fatigue worsens  Erythema with or without blisters; hyperkeratotic lesions on palms and soles  Commonly accompanied by dysesthesia (burning, pain, tingling)  Perform full-body skin examination, focusing on deformities and hyperkeratotic areas on palms and soles, before treatment initiation  Have patients remove their shoes and examine their feet during each visit  Recommend podiatrist evaluation (can help with removal of calluses and hyperkeratotic regions) and orthotist evaluation and use of orthotic devices in patients with abnormal weight bearing  During early therapy (2-4 wk), encourage rest and avoidance of vigorous exercise and traumatic activity Medical Intervention General Management Symptoms Prophylaxis Immunotherapy VEGF TKI Pruritus Pneumonitis Myocarditis Adrenal crisis Hypertension Taste changes Stomatitis Dyspepsia Cytopenias HFSR Rash Diarrhea Hepatitis Hypothyroid AMS Encephalitis PRES