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AFINITOR is a once-daily oral inhibitor of mTOR (mammalian target of rapamycin) for patients with advanced renal cell carcinoma (RCC) whose disease has progressed on or after treatment with VEGF-targeted therapy
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About Estela

Information on a possible treatment option for patients with advanced RCC1

  • The treatment of advanced RCC has evolved, and effective options for patients with disease refractory to kinase inhibitors such as sunitinib now exist
  • A Phase III trial provides evidence of PFS prolongation by AFINITOR after progression on a VEGF-targeted agent such as sunitinib
  • The AFINITOR pivotal trial is the first Phase III, prospective, randomized, double-blinded, placebo-controlled trial to demonstrate a clinical benefit after sunitinib or sorafenib failure

Professional Resources

References:

  1. Motzer RJ, Escudier B, Oudard S, et al; for the RECORD-1 Study Group. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet. 2008;372(9637):449-456.

About Estela

The most likely answer is All of the above.

Similar to second-line treatment, there are multiple factors to weigh in the subsequent treatment of mRCC. Among these are comorbidities (e.g., hypertension), PS, previous therapy, the type and duration of progression, clinical efficacy and safety data of the proposed next agent, and other patient-related factors (e.g., insurance coverage, preference, concurrent therapies).1-4

References:

  1. National Comprehensive Cancer Network®. NCCN clinical practice guidelines in Oncology (NCCN Guidelines™). Kidney cancer. Version1.2011. http://www.asco.org. Accessed November 2010. Urology. 2009.
  2. Ljungberg B, Hanbury DC, Kuczyk MA, et al. Guidelines on renal cell carcinoma. European Association of Urology. 2009.
  3. Thompson Coon J, Hoyle M, Green C, et al. Bevacizumab, sorafenib tosylate, sunitinib and temsirolimus for renal cell carcinoma: a systematic review and economic evaluation. Health Technol Assess. 2010;14(2):1-184, iii-iv.
  4. Bellmunt J, Flodgren P, Roigas J, Oudard S. Optimal management of metastatic renal cell carcinoma: an algorithm for treatment. BJU Int. 2009;104(1):10-18.

About Estela

Which of the following criteria do you consider when making your third-line treatment decision for Estela?

Select an answer below.






About Estela

Which of the following would you choose as third-line treatment for Estela?

Select an answer below.






About Estela

The most likely answer is All of the above.

Clinicians have a host of clinical-, disease-, treatment-, and patient-related factors to consider when selecting second-line treatment of mRCC. These include but are not limited to comorbidities (e.g., hypertension), PS (e.g., Karnofsky, ECOG), previous therapy, individual patient factors (e.g., insurance coverage, costs, preference/lifestyle, concurrent therapies), the type and duration of progression, and clinical efficacy and safety data of the proposed next agent.1-4

References:

  1. National Comprehensive Cancer Network®. NCCN clinical practice guidelines in Oncology (NCCN Guidelines™). Kidney cancer. Version1.2011. http://www.asco.org. Accessed November 2010.
  2. Ljungberg B, Hanbury DC, Kuczyk MA, et al. Guidelines on renal cell carcinoma. European Association of Urology. 2009.
  3. Thompson Coon J, Hoyle M, Green C, et al. Bevacizumab, sorafenib tosylate, sunitinib and temsirolimus for renal cell carcinoma: a systematic review and economic evaluation. Health Technol Assess. 2010;14(2):1-184, iii-iv.
  4. Bellmunt J, Flodgren P, Roigas J, Oudard S. Optimal management of metastatic renal cell carcinoma: an algorithm for treatment. BJU Int. 2009;104(1):10-18.

About Estela

Which of the following criteria do you consider when making your second-line treatment decision for Estela?

Select an answer below.






About Estela

While in the hospital, doctors discover that Estela's disease progressed. Which of the following would you choose as a second-line treatment for Estela?

Select an answer below.






About Estela

Physical exam findings in the emergency room

Estela's physical exam in the hospital revealed the following.

  • MUGA ejection fraction scan indicated left ejection fraction of 33%
  • Confirmed congestive heart failure
  • Due to intolerable treatment-related toxicity, sunitinib is discontinued
  • Estela is hospitalized for further evaluation

About Estela

"My cancer doctor gave me a prescription for sunitinib. I took the drug like I was supposed to, but I missed a couple of appointments because of bad weather. A few months after I started the drug I was cleaning my apartment and got sick: I could hardly breathe, was very tired, and my heart was pounding. Harry, my neighbor, called 911 and paramedics drove me to the local hospital..."

About Estela

Oncologist's notes:

  • Reviewed drug therapy options with patient
  • Patient agreed to start therapy with sunitinib 50 mg PO, 4 weeks on, 2 weeks off therapy
  • Due to inclement weather and no transportation, patient cancelled follow-up appointments
  • Practice nurse followed-up by phone twice; no answer

About Estela

Imaging study results:

  • CT scan revealed multiple 4- to 5-cm lesions in left lung

About Estela

"Much to my dismay, I was diagnosed with kidney cancer. With the help of a support group and my neighbors, I learned to cope and I learned a lot about how to care for myself. Four years after my surgery, a follow-up x-ray showed that the cancer had spread and was now in my lung."

About Estela

Laboratory report:

  • WBC: 8.6
  • LDH: 500 U/L
  • Hb: 9.8 g/dL
  • Platelets: 86
  • Calcium: 11.5 mg/dL
  • Urinalysis: shows blood
  • Serum creatinine: 1.3 mg/dL

About Estela

Oncologist's notes:

  • Referred by PCP; patient reported chronic cough, fatigue, and back pain
  • No history of tobacco use
  • No major comorbidities
  • Current medications: aspirin (daily); multivitamin (daily); herbal supplements (occasional use)
  • Family history: lung cancer; bladder cancer; myocardial infarction
  • Ultrasound scan showed 6.0 cm x 4.0 cm solid lesion in left kidney; biopsy revealed RCC, clear cell histology
  • No evidence of distant metastases
  • ECOG PS=1
  • Scheduled radical left nephrectomy

About Estela

"My name is Estela. I'm a 63 year old grandmother of 2 and live alone in an inner city government housing development for senior citizens. It all started with a cough that no matter what I did or took, it would not stop. I also felt tired all over and had severe back pain, especially when I tried to lift or bend to reach something. I went to see my family doctor for a checkup. At the end of the appointment, she explained her findings and referred me to a community cancer doctor..."