Cytokine Therapy in RCC

CE / CME

The Evolving Role of Cytokine Therapy for Renal Cell Carcinoma: Past, Present, and Future

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit

Nurses: 1.00 Nursing contact hour

Released: October 01, 2020

Expiration: September 30, 2021

Activity

Progress
1
Course Completed

In this module, Brendan D. Curti, MD, offers an overview of systemic therapy in the treatment of renal cell carcinoma (RCC), including the use of high-dose (HD) interleukin 2 (IL-2), immune checkpoint inhibitors (ICI), and combinations of tyrosine kinase inhibitors (TKIs) with ICIs. The role of nephrectomy in patients with metastatic RCC is also discussed.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset that can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Several questions will be asked twice: once at the beginning of the activity, and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many patients with RCC do you provide care for in a typical month?

How confident are you in selecting patients that would benefit from HD-IL2 therapy?

Which of the following outcomes was reported from a retrospective analysis of the use of HD IL-2 following treatment with ICI therapy?

Case Vignette/Patient History:

A 67-year-old man presented with low back pain. CT imaging showed:

 

At presentation, metastatic sites included bone (multiple), lung (~ 50 nodules), and multiple lymph nodes, primarily in the chest and hilar area. During his evaluation, he had a pathologic fracture of his right femur requiring urgent surgical stabilization and management. A femoral nail was placed and pathology was submitted from that operation, confirming the clinical suspicion of metastatic clear-cell RCC. 

Relevant laboratory tests at the time of presentation showed a normal white blood cell count, but the patient was anemic without any clinical evidence of blood loss. Hemoglobin was 10.4 g/dL, hematocrit was 30.4%, platelets were elevated at a level of 531,000/µL, and the corrected calcium was greater than the upper limit of normal. Using International Metastatic RCC Database Consortium (IMDC) criteria, this patient would be classified as poor risk, and based on that model, his median survival would be estimated at 7.8 months.

In your current clinical practice, would you recommend a nephrectomy for this patient?
In your current clinical practice, what systemic therapy would you recommend for this patient?