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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 Tom

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 Tom

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.
  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 Tom

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

Select an answer below.






About Tom

Eventually, Tom's disease progresses. Which of the following would you choose as third-line treatment for Tom?

Select an answer below.






About Tom

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, the type and duration of progression, clinician's experience with proposed treatment(s), as well as individual patient factors (e.g., insurance coverage, costs, preference/lifestyle, 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.
  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 Tom

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

Select an answer below.






About Tom

Which of the following would you choose as second-line treatment for Tom?

Select an answer below.






About Tom

Oncologist's notes:

  • After reviewing imaging results, Tom and his doctor agreed to discontinue sunitinib because of disease progression

About Tom

Imaging study results:

Click on Tom's MRI scan to obtain results.

  • Coronal MRI revealed 2 lesions in right kidney

About Tom

"Immediately after this office visit, I filled the prescription and took the medication as he directed. I returned to my doctor's office for a 13-month follow-up appointment..."

About Tom

Oncologist's notes:

  • Embolization of left renal artery, with radical left nephrectomy
  • Patient discharged from the hospital
  • Patient not a candidate for partial right nephrectomy due to left nephrectomy
  • Issue of treatment for mRCC was discussed with Tom and his son, and systemic therapy was recommended
  • Tom agreed to sunitinib (50 mg PO QD); 4 weeks on therapy and 2 weeks off

About Tom

"I didn't even know a thing about RCC and here I am, in the hospital and diagnosed with it. The next step in my journey was surgical removal of my left kidney. After surgery, I was referred to a medical oncologist for follow-up..."

About Tom

Imaging study results:

  • CT scan confirmed a 7.5-cm x 8.0-cm mass in left kidney
  • Biopsy revealed clear-cell histology type
  • Bone scan revealed metastatic disease
  • Memorial Sloan-Kettering Cancer Center (MSKCC) prognostic score: intermediate

About Tom

Laboratory report:

  • WBC: 11.65 x 103/μL
  • LDH: 650 U/L (ULN=625)
  • Hb: 14.2 g/dL (LLN=14.0)
  • Platelets: 646 x 103/μL
  • Calcium: 8.9 mg/dL (corrected: 9.4 mg/dL)
  • Urinalysis: reddish tinge, multiple RBCs on microscopic examination
  • Serum creatinine: 1.2 mg/dL (ULN=1.4)

About Tom

Physical exam findings in the emergency room:

  • BP=150/95 mm Hg
  • Pulse rate=110
  • Recommended that Tom be hospitalized for further evaluation

About Tom

"My name is Tom. I'm a former truck driver and business owner, I'm 68 years old, and have 3 grown children. It was severe abdominal pain that prompted my youngest son to take me to the emergency room at our community hospital..."