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RCC Outcomes Optimization

CE / CME

Optimizing Outcomes for Patients With RCC

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Released: April 07, 2023

Expiration: April 06, 2024

CME/CE Information

Activity

Progress
1
Course Completed

Key Takeaways

In summary, the management of RCC has evolved over the past several years and will continue to evolve as more treatment options emerge. CCO is working to update an Interactive Decision Support Tool with 5 experts, including myself, that will highlight these treatment evolutions. The tool will provide recommendations for treatment choice in the first-, second-, and third-line settings for patients with metastatic clear cell RCC considering patient-specific characteristics, risk status, and prior treatment regimens.

Adjuvant therapy with pembrolizumab can be considered in patients who are T3 high risk or M1 NED within 1 year of surgical resection. Adjuvant therapy should be a risk vs benefit discussion with patients to ensure that they understand the potential short-term and long-term AE profiles.

Initial therapy of metastatic RCC has evolved from monotherapy TKIs to the use of immunotherapy doublets in the form of IO/VEGF TKI combinations or dual immune checkpoint inhibition with a PD-1/CLTA-4 inhibitor. The most commonly used regimens for frontline treatment are axitinib/pembrolizumab, cabozantinib/nivolumab, lenvatinib/pembrolizumab, and ipilimumab/nivolumab. The 3 IO/TKI combinations are approved for all IMDC risk categories, whereas ipilimumab/nivolumab is indicated only for those with intermediate/poor-risk disease. Selection of frontline treatment is an individualized decision made on a case-by-case basis and should take into consideration the disease biology, as well as patient-specific factors including comorbidities and treatment AE profiles.

Similarly, in the R/R setting, treatment options are expanding. In addition to the treatment selection factors listed above for frontline treatment, healthcare professionals should take into consideration both the drug and drug class the patient received in the frontline setting.

All of the treatment options have associated AEs. A thorough consenting process and ensuring that patients understand the timeline for when AEs can occur is critical; irAEs can occur at any time during treatment and can be life-threatening if not recognized and managed appropriately.

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