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

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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.

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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.

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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!