Cancer Treatment Today » Renal (Kidney) Cancer

Afinitor and Nexavar or Votrient – pro

M Levin, MD — Fri, 31 Aug 2012 13:19:12 +0000

Everolimus has been approved by the US Food and Drug Administration (FDA) as the first oral, daily therapy (5 mg and 10 mg tablets) to treat advanced kidney cancer after failure of treatment with sunitinib or sorafenib. The NCCN lists it for both first and second line therapy. The approach of tailoring treatment with this drug in combination with other biologicals based on molecular profiles is potentially promising but it is not supported by the literature.

Afinitor was studied in several combination trials. AFINITOR® is indicated for the treatment of adult patients with advanced renal cell carcinoma (RCC) after failure of treatment with sunitinib or sorafenib. The RECORD-1 trial included only renal cell carcinoma histology

Afinitor, Prescribing Information 2016

P. Cen, A. Daleiden, G. Doshi, R. Amato; A phase I study of everolimus plus sorafenib in patients with metastatic renal cell carcinoma (mRCC). J Clin Oncol 27, 2009 (suppl; abstr e16056)

nccn.org, kidney cancer 2016

B. Escudier et al, Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†Ann Oncol (2012) 23 (suppl 7): vii65-vii71.

I had not been able to find any published studies of the combination of Votrient and Afinitor. I found one study: Pazopanib and Everolimus in Patients With Advanced Solid Tumors and Previously Treated Kidney Cancer, NCT01184326. This research study is evaluating the combination of pazopanib and everolimus in patients that have a malignancy that is metastatic or unresectable and for which standard curative or palliative measures do not exist or are no longer effective, or metastatic or locally advanced unresectable kidney cancer. In this research study the investigators are testing the safety of the combination of pazopanib and everolimus as well as to find the appropriate dose to use for further studies.

Afinitor, Prescribing Information

P. Cen, A. Daleiden, G. Doshi, R. Amato; A phase I study of everolimus plus sorafenib in patients with metastatic renal cell carcinoma (mRCC). J Clin Oncol 27, 2009 (suppl; abstr e16056)

nccn.org, kidney cancer 2012

Cryoablation of kidney cancer – pro

M Levin, MD — Tue, 28 Aug 2012 18:35:06 +0000

Standard approach to kidney cancers is surgical resection, usually a complete nephrectomy, although partial nephrectomies are sometimes done when sparing renal function is imperative. Small renal masses have recently been treated by cryoablation (freezing to at least -19.4 °C using liquid nitrogen or argon). In cryoablation, a small freezing probe is insertead through the skin, and its tip is placed into the cancerous tissue using CT and ultrasound guidance. Retrospective studies suggest an around 95% success rate. Subsequent MRI or CT scans are used to evaluate the ablation, with diminution of the tumor in the cryolesion and lack of contrast enhancement considered a favorable result, and increase of the tumor in the cryolesion or interval growth considered signs of inadequate treatment. A percutaneous biopsy, a standard resection, or retreatment with cryoablation can then occur. The mechanism leading to tumor destruction is uncertain and may be a combination of direct cytotoxicity and damage to vascular elements leading to ischemic necrosis. The cryoablation studies carried out to date fail to convince that a potentially malignant renal mass has been eradicated. The uncertain biopsy data before and after ablation, short follow-up, and requirements for lengthy general anesthesia and frequently for laparoscopic surgical intervention, weaken the argument for renal cryoablation as a paradigm shift. The U.S. Food and Drug Administration approved this treatment for kidney cancer, but research studies still need to measure long-term outcomes to compare cryoablation to other treatments.Kaouk JH, Aron M, Rewcastle JC, Gill IS. Cryotherapy: clinical end points and their experimental foundations. Urology 2006;68(1 suppl):38–44.[Paul Russo Renal cryoablation: a new treatment in need of careful clinical investigation Nature Clinical Practice Oncology (2006) 3, 286-287

Chromophobe (ChRCC) Type Renal Cell Cancer – pro

M Levin, MD — Tue, 19 Jun 2012 21:45:30 +0000

Chromophobe(ChRCC) renal cell cancer is rare. Unfortunately, there are no proven treatment for the metastatic disease. At one time chemotherapy was thought to be effective but studies did not confirm it. Overexpression of CD117 on cellular membranes of ChRCC could be a potential target for kinase inhibitors like: imatinib, dasatinib, nilotinib. The potential targets for other kinase inhibitors (sunitinib and sorafenib) in ChRCC seem to be VEGFR and PDGFR. In conclusion, these observations are the basis for formulating research hypotheses which should be verified in prospective studies.

B. Escudie,r V. Kataja Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Ann Oncol (2010) 21 (suppl 5): v137-v139.

Rafał Stec et al, Chromophobe renal cell cancer – review of the literature and potential methods of treating metastatic disease Journal of Experimental & Clinical Cancer Research 2009, 28:134

Rini BI, Escudier B, Tomczak P, Kaprin A, Szczylik C, Hutson TE, Michaelson MD, Gorbunova VA, Gore ME, Rusakov IG, Negrier S, Ou YC, Castellano D, Lim HY, Uemura H, Tarazi J, Cella D, Chen C, Rosbrook B, Kim S, Motzer RJ Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3 trial. Lancet. 2011 Dec 3;378(9807):1931-9.