ESMO Preceptorship Programme
Systemic Therapy in Metastatic RCC
Dr. Martina Pagliuca, M.D.
Medical Oncology Division
Department of Clinical Medicine and Surgery
University Federico II of Naples, Italy
Metastatic Bladder and Kidney Cancer – Zurich – 23-24 November 2018
ESMO PRECEPTORSHIP PROGRAMME
DISCLOSURE OF INTEREST
No conflicts of interest to declare
ESMO PRECEPTORSHIP PROGRAMME
RCC diagnosis
� MR, a 51 years old man without comorbidities except for G6PD
deficiency. Performance status ECOG 0.
� He underwent left radical nephrectomy in November 2012.
Pathology: high grade clear cell Renal Cell Carcinoma pT3 NX.
� Postoperative CT: Para aortic limph nodes and vertebral (D8)
metastases.
� Advanced disease.
MSKCC intermediate-risk patient
ESMO PRECEPTORSHIP PROGRAMME
First line therapy
� Sunitinib 50 mg once daily 4 weeks on/2 weeks off.
� Denosumab 120 mg every 4 weeks.
� AEs: hypothyroidism G2, hand-foot syndrome G1, dysgeusia G1,
anal and genital mucositis G1, fatigue G1, diarrhea G2, arterial
hypertension G2.
� Best objective response: SD.
� Switch to 2 weeks on/1 week off schedule and subsequent dose
reduction (37,5 mg) due to toxicities reported.
ESMO PRECEPTORSHIP PROGRAMME
Second line therapy
� PD at CT performed on February 2018: ascites, multiple bone
metastases, stability of the para aortic limph nodes metastases.
� Immunotherapy with Nivolumab 240 mg every two weeks.
� After two cicles immune-related colitis G3 occurred:
� Gastroenterological assessment was performed;
� Colonoscopy, endoscopic findings: ulcerative colitis;
� Predisone 75 mg daily.
ESMO PRECEPTORSHIP PROGRAMME
Second line therapy
� Complete remission of symptoms with Prednisone 1 mg/kg within 5
days.
� Recurrence of diarrhea during oral corticosteroids tapering.
� Nivolumab based immunotherapy discontinuation in agreement with
the patient.
� SD at the CT scan performed in May 2018.
ESMO PRECEPTORSHIP PROGRAMME
Third line therapy
� Cabozantinib 60 mg orally once daily.
� AEs: diarrhea G3, fatigue G1, hypothyroidism G1.
� Dosage reduction 40 mg orally once daily due to the toxicities
occurred.
� Best objective response: SD.
� The therapy is currently ongoing. Routinary ambulatory visit once a
month.
ESMO PRECEPTORSHIP PROGRAMME
Conclusions
� Appropriate supportive therapy and correct timing in dose
management may ensure full benefit from the different therapeutic
approaches.
� Well established treatments are sometimes uneffective and
detrimental.
� Although such a long-term survival is not achievable for all cases,
personalization of systemic treatment should be encouraged for every
mRCC patients.
ESMO Preceptorship Programme
“Normal cells are identically normal; malignant cells become
unhappily malignant in unique ways.”Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer
Thank you for your attention!
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