Principles of Systemic Therapy or Stage IV Disease First Line Therapy for Clear Cell Histology

Question 1

Drug classes of first line and second line treatments?

Answer 1

Tyrosine kinase inhibitors

Anti-VEGF antibodies

Question 2

Drug class that alters the interaction the interaction between immune cells and antigen presenting cells, including tumor cells.

Answer 2

Immune checkpoint inhibitors

Question 3

3 most common histologic RCC types according to the WHO

Answer 3

Clear cell
Papillary
Chromophobe

Question 4

Preferred regimens for FAVORABLE clear cell RCC

Answer 4

1. Axitinib + Pembrolizumab
2. Pazopanib
3. Sunitinib

Question 5

Preferred regimens for POOR/INTERMEDIATE (CAT 1)

Answer 5

1. Ipilimumab + Nivolumab (Cat 1)
2. Axitnib + Pembrolizumab (Cat 1)
3. Cabozantinb

Question 6

Category 1 preferred regimens for subsequent therapy for Clear cell histology

Answer 6

Cabozantinib (Cat 1)

Nivolumab (Cat 1)

Question 7

Good prognostic features and good performance status, but with lung mets. Is this patient still eligible for cytoreductive nephrectomy?

Answer 7

Yes

Question 8

CARMENA phase III trial showed that sunitinib alone is non-inferior to sunitinib after nephrectomy, true or false?

Answer 8

True

Question 9

Timing of systemic therapy in surgically unresectable masses?

Answer 9

After recurrence

Question 10

Oral angiogenesis inhibitor targeting VEGF 1, 2, 3, PDGF alpha and beta, and stem cell factor receptor CKIT.

Answer 10

PAZOPANIB

Question 11

Notable grade 3 toxicity of Pazopanib?

Answer 11

HEPATOTOXICITY

Question 12

Between pazopanib and sunitinib, which has the better efficacy profile?

Answer 12

SIMILAR EFFICACY PROFILE

Question 13

Between pazopanib and sunitinib, which is associated with less fatigue, less hand-foot syndrome, less alteration in taste, less thrombocytopenia?

Answer 13

PAZOPANIB

Question 14

Selective blocker the interaction of programmed death-1 (PD-1 on activated T-cells) and its ligands, used as first line therapy for patients with intermediate and poor risk RCC.

Answer 14

NIVOLUMAB

Question 15

Selective blocker of the negative regulator cytotoxic T-lymphocyte antigen 4 (CTLA-4) and its ligands CD80 and 86 used as first line therapy for patients with intermediate and poor risk RCC.

Answer 15

IPILIMUMAB

Question 16

Small molecule inhibitor of tyrosine kinases such as VEGFR, MET and AXL used as first line therapy for clear cell RCC poor and intermediate.

Answer 16

CABOZANTINIB

Question 17

Bevacizumab (monoclonal antibody that binds and neutralizes circulating VEGF-A) in combination with what drug is used for highly selected patients with relapsed or medically unresectable stage IV clear cell RCC.

Answer 17

INTERFERON ALPHA

Question 18

mTOR protein inhibitor used as a category 1 first line treatment of poor risk patients with relapsed or medically unresectable clear cell stage IV RCC.

Answer 18

TEMSOROLIMUS

Question 19

Second gen inhibitor of VEGFR123 as first line therapy for clear cell RCC.

Answer 19

AXITINIB