ESMO E-Learning: First-line Therapy for Renal Cell Carcinoma: Defining New Standards of Care from Phase III Trials

Learning Objectives

  1. To provide an essential update on targeted agents available for the treatment of patients with renal cell carcinoma
  2. To summarise data from recent phase III trials and put into clinical perspective how best to incorporate innovative therapeutics into treatment algorithms
  3. To provide an update on treatment approaches that are currently under investigation in patients with renal cell carcinoma
Title Duration Content CME Points CME Test
First-line Therapy for Renal Cell Carcinoma: Defining New Standards of Care from Phase III Trials 63 min. 46 slides 1 Take Test
bellmunt-joaquim
Joaquim Bellmunt
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This E-learning module has been developed in order to discuss the current standard of care in patients with renal cell carcinoma (RCC). The therapeutic approach has been dramatically changed in these patients in the era of targeted therapy. In the past, metastatic RCC had been associated with poor prognosis and limited effective treatments. However, in the last several years a strong biological rationale for therapeutic targeting in RCC has been demonstrated. VEGF and mTOR are important therapeutic targets. In addition, the activity of multi-targeted agents has been widely reported.

In recent years, several drugs have been approved for the management of RCC patients. Their approval and the fast development of other agents posed a clinical dilemma regarding how best to incorporate them in the therapeutic armamentarium. It also posed a clinical challenge on how optimally to use these agents in the sequence of other available treatment modalities for maximal clinical benefit.

To illustrate the complexity of the rapid clinical development of new agents in RCC, the author outlines how to choose targeted agents in first line treatment, coming to the conclusion that sunitinib, pazopanib, bevacizumab (plus IFN) and tivozanib have shown improved progression-free survival (PFS) in phase III trials. Standard front line therapy for most patients is VEGF tyrosine kinase inhibitor (TKI), likely pazopanib or sunitinib based on tolerability and quality of life versus minor efficacy differences.

In his presentation the author further explores the role of second-line therapy after failure of anti-VEGF therapies concluding that for most patients the standard second line therapy is everolimus or axitinib. He provides an expert opinion that the optimal scenario should consider exposure to both TKI and mTOR in second and third lines. He also summarises early signals observed with newer targeted and immunotherapy agents and concludes that combination therapy seems to add toxicity but not necessarily efficacy. Adjuvant therapy in RCC remains under investigation.

This E-learning module is an excellent CME activity for all those interested in the management of patients with RCC. It puts into clinical context the currently available evidence and provides an update on the therapeutic horizon in this setting.

Last update: 18 February 2014

The Author has reported to have received honoraria from Adboards and lectures fee from Pfizer, GSK and Novartis.