Renal Cell Cancer Flashcards Preview

Medical oncology > Renal Cell Cancer > Flashcards

Flashcards in Renal Cell Cancer Deck (141):
1

Why is the vHL protein instrumental in the development of RCC?

VHL protein combines with hydroxyproline. This activates Hypoxia-inducible factor alpha, which is then degraded by a proteasome.

Withy hypoxic environments (as in a tumor), or in patients with abnormal vHL protein (as in ccRCC), HIFalpha is activated, inducing hypoxia-inducible genes.
- eg. VEGF and PDGF

2

How does the MSKCC Criteria 2002 correlate with survival?

0 risk factors = 30 months
1 or 2 = 14 months
3 or more = 5 months

3

What is the Heng index?

By Daniel Heng 2009

Validated components of the MSKCC score, and serves as a prognostic score for OS in patients tx with VEGF agents

6 components:

- Hb ULN
- Neutrophils > ULN
- PS ULN

3 risk categories:
- 0 = Favorable = mOS not reached, 2y OS 75%
- 1 or 2 = intermediate = mOS 27m, 2y OS 53%
- 3 or more = poor = mOS 9m, 2y OS 7%



4

What is the limitation of MSKCC?

Derived from the era of immunotherapy and are limited to a population of patients eligible for participation in immunotherapy clinical trials.

Unclear if the same prognostic factors are relevant to those with VEGF-targeted therapy.

5

What is the only curative modality of mRCC?

High-dose IL-2

JCO 1995 Gwendolyn Fyfe

N=255, phase II
Met RCC
Proleukin (Aldesleukin), 600 000 or 720 000 IU/kg q8H x 14 doses (over 15min infusion) over 5 days
Supportive measures
2nd cycle after 5-9 days of rest
Courses could be repeated every 6-12 weeks in stable or responding patients

Results:
- ORR 14% , 5% CR, 9% PR
- med Duration of response for CR 80m, 20m in PR pts
- 4% mortality secondary to treatment

6

What is the evidence for using Sunitinib over Alpha-Interferon?

Motzer 2007, 2009

Aim: Prove in RCT that Sunitinib is efficacious in met RCC

N=750, prep untreated, mRCC, phase III
2 arms:
A) Sunitinib 50mg OM x4weeks, q6Weeks
B) Subcut Alpha IF 9MU 3x/week

Results:
- PFS 11m vs 5m HR 0.42
- ORR 30% vs 6%
- Fatigue more in Alpha IF, diarrhea more in SUnitinib
- Better QoL with Sunitinib

Updated 2009:
- mOS 26m vs 22m HR 0.8
- med PFS 11m vs 5m (primary endpoint)
- ORR 50% vs 10%
- most common S/E with Sunitinib = fatigue, HTN, diarrhea, HFS

7

What is the evidence for Temsirolimus?

Gary Hudes NEJM 2007

RCT phase III, n= 600
Prev Untx poor-prognosis mRCC

3 arms:
- IV Temsirolimus 25mg weekly
- Alpha IFN 3 million U SC 3x/week (with increase up to 18million)
- Temsirolimus 15mg weekly + IFN 6million U 3x /week

Results:
- Temsirolimus = longer OS HR 0.73 and longer PFS
- OS in combi group = IFN group
- Med OS:
>> 7m (IFN) vs 11m (Tem) vs 8m (Combi)
- S/e Tem: rash, peripheral edema, hyperglycemia, hyperlipemia

8

Tell me about the AVOREN trial

Aim :whether combination of Bev + IFN will be more efficacious

RCT phase 3, n=650, prep untreated mRCC

2 arms:
- IFN 9MIU SC 3x/week + Bev 10mg/kg q2W
- placebo and IFN alpha 2a

Results:
- mPFS 10m (Combi) vs 5m HR 0.63

9

What is the evidence of Pazopanib?

Sternberg JCO 2010
Aim: to evaluate efficacy + Safety in Tx-naive and cytokines-pretreated adv RCC

N=400

2arms (2:1)
Pazopanib vs placebo

Results:
PFS: 9m vs 4m HR 0.5
- Tx naive: med PFS 11m vs 3m HR 0.4
- cytokines-pretx: med PFS 7m vs 4m HR 0.5
ORR: 30% with Pazopanib and 3% with placebo

10

Tell me about the COMPARZ study

Aim :
Non-inferiority study to compare Pazopanib against Sunitnib in 1st line setting

N=1100 , ccRCC, met RCC
2 arms:
- Pazopanib 800 mg OM
- Sunitnib 50 mg Q4w Q6w

Results:
- PFS and OS similar
- Sunitnib had higher incidence of fatigue, HFS, thrombocytopenia
- Pazopanib had higher incidence of raised ALT

Result: similar efficacy. Safety and QoL favor Pazopanib

11

Tell me about the TARGET Trial

N=900

2 arms:
Sorafenib vs Placebo
Cross-over allowed when PFS benefit was shown

Results:
Final OS: 18m vs 15m

12

Evidence for Everolimus?

Motzer

Met RCC patients who had PD on Sunitnib, Sorafenib or both.

2 arms:
Everolimus 10 mg OM or placebo

Results:
Med PFS 4m (Everolimus) vs 2m
8% pneumonia is rate with Everolimus

13

Tell me about the AXIS trial

Aim= Compare Axitinib vs Sorafenib as 2nd line Tx for met RCC

N=700
2nd line tx
1st line= Sunitnib, Bev+IFN, Temsirolimus, cytokines

2 arms:
A) Axitinib 5mg BD
- can increase to 7mg, then 10mg BD in those who can tolerate
B) Sorafenib 400 mg BD

Results:
Med PFS 7m vs 5m HR 0.7
Txt discontinuation in 8% (Sorafenib) vs 4%

14

What about the INTORSECT study ?

Hutson et al

Aim: To investigate efficacy of Temsirolimus vs Sorafenib as 2nd line after Sunitnib

N=500
PD on Sunitinib

2 arms:
- IV Temsirolimus 25mg once a week
- Oral Sorafenib 400mg BD

Results:
- med PFS 4.3m (Tem) vs 3.9 (Sorafenib)
- med OS 12.3m (Tem) vs 16.6 (Sorafenib)

Conclusion:
- 2nd line Tem did not show a PFS advantage as compared to Sorafenib
- OS advantage with Sorafenib suggests sequenced VEGFR inhibition may benefit patients with mRCC

15

Which is better? Pazopanib or Sunitnib and why?

PISCES study

N=110
No prior therapy

2 arms:
- Pazopanib 800 mg OM x 10weeks --> Sunitinib
- Sunitnib 50mg 4/2 x 10 weeks --> Pazopanib
- 2-week washout in between
- off study after 22 weeks, (10weeks -->2w-->10w), off study, put choice of tx to PD

Results:
- Preference:
>>Pazopanib-->Sunitnib 80% preferred Pazopanib
>>Sunitinib --> Pazopanib: 60% preferred Pazopanib

16

What do you know about sequencing of treatment in mRCC?

RECORD-3 Motzer JCO 2014

Aim: Wanted to assess if 1st line Everolimus--> Sunitinib was the same as Sunitinib--> Everolimus

N=470

Results:
Med PFS:
- 8m 1st line Everolimus
- 11m 1st line Sunitinib
Med Combined PFS:
- 21m 1st line Everolimus
- 26m 1st line Sunitinib
Med OS:
- 22m 1st line Everolimus
- 32m 1st line Sunitinib

Results:
Still Sunitinib --> Everolimus

17

What do you know about Sequential TKIs in Adv RCC?

Sablin et al 2007

Retrospective studies suggest activity to 2nd agent
No obvious correlation of response to first TKI with response to second TKI

18

What do you know about using Cabozantinib ?

Choueiri NEJM 2015

Cabozantinib = oral, small-molecule TKI that targets VEGFR, MET and AXL

RCT aim to compare Cabozantib vs Everolimus in mRCC who had PD after VEGFR-targeted therapy
- but no previous mTOR inhibitors

N=650
2 arms:
- Cabozantinib
- Everolimus

Results:
- med PFS 7m with Cabo and 4m with Everolimus
- ORR 20% with Cabo and 5% with Everolimus
- OS longer with Cabo HR 0.7
- Dose reduction rate higher with Cabo, but discontinuation of study treatment similar at rate of 10%

19

Name the common side-effects of Sunitinib?

Fatigue
GI disorders
Dysgeusia
LOA
HTN
HFS
Skin discoloration
Mucosal inflammation
Rash

20

Name the side effects with Sorafenib

Diarrhea
Rash
Alopecia

21

Name the side effects with Temsirolimus

Asthenia
Anemia
Rash
GI disorders
Oedema
Metabolic disorders
Displeasure
Pain
Cough
Bacterial infections

22

Name the side-effects of Bev/IFN-alpha

Anorexia
Fatigue/Asthenia
Hemorrhage
HTN
Influenza-like illness
Headaches
Diarrhea

23

Explain re: Sunitinib and cardiotoxicity

All-grade LVEF decrease 15%, G3-4 3%

Sunitinib discontinuation in presence of clinical manifestations of CHF

Interrupt dose or dose reduce in those without clinical evidence of CHF but with LVEF 20% decrease below baseline

24

Tell me about the checkmate 025 study for met RCC

Phase 3, RCT n = 800
Adv ccRCC
Previous 1 or 2 regimens of antiangiogenic therapy
2 arms:
A) IV Nivolumab 3mg/kg q2weekly
B) PO Everolimus 10mg OM

Primary endpoint = OS

Results:
- Med OS 25m vs 20m
- ORR 25% vs 5%
- med PFS similar 4m
- G3/4 tx-related adverse events 20% v 40%

25

How do you manage HFSR?

Grade 0 = prophylactic care
- avoid excessive friction, vigorous exercise
- thick cotton socks/gloves

Grade 1 = numbness, parenthesis, dysaesthesia, painless swelling, erythema
- avoid hot water
- moisturize
- Urea 20-40%
- thick cotton socks/gloves

Grade 2 = Painful erythema, swelling, interferes with ADLs
- as above
- dose reduce 50% for 7-28days
- potent topical steroids ointment
- pain relief with oral painkiller eg codeine

Grade 3 = moist desquamation, ulceration, blistering, severe pain, interferes with ADLs
- Dose interruption at least 7 days, till improvement to grade 0 or 1
- further dose reduce by one dose level

For Grades 2 and 3, require 2 weekly review

26

Describe ccRCC

75-90% incidence

Genetic features:
-3p deletion, -6q,-8p,-9p,-14q
+5q insertion
VHL

VEGFR and mTOR-directed therapy

27

Describe papillary RCC

10-15% incidence

Genetics:
- cMET (Type I)
- Fumarate hydratase (Type II)
- -Y

Sunitinib, Sorafenib, Temsirolimus, +/- Everolimus and Bev, MET-directed therapy

28

Describe chromophobe RCC

4-5%,
Birt-Hogg-Dube syndrome
Tend o present with lower stage and grade than ccRCC with very low incidence of mets

Overall prognosis may be no different to ccRCC

Sunitinib, Sorafenib, Temsirolimus, Everolimus, Pazopanib,

29

What are the components of MSKCC Criteria (2002)?

KPS 2.5 mmoL/L
Time from Dx to treatment with IFN

30

Talk about collecting ducts of Bellini RCC

31

What is the T1 and T2 for Kidney cancer?

T1 = Tumor 7cm or less, limited to kidney
T1a T4cm or less
T1b Tumor 4-7cm

T2= Tumor limited to kidney, >7cm
T2a = Tumor >7cm, up to10cm
T2b = Tumor >10cm, but limited to kidney

32

What is T3 and T4 of kidney cancer staging?

T3 = tumor extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota's fascia
T3a = tumor grossly extends into renal vein or its segmental branches, or tumor invades perirenal and/or renal sinus fat but not beyond Gerota's fascia
T3b = Tumor grossly extends into vena cava below diaphragm
T3c = Tumor extends into vena cava above diaphragm or invades wall of vena cava

T4 = Tumor invades beyond Gerota's fascia (including contiguous extension into ipsilateral adrenal gland)

33

Tell me about the staging of RCC

Stage I - T10N0M0
Stage II - T2N0M0

Stage III - T3N0-1 or T1-2N1M0

Stage IV - as long as T4 or M1

34

What is the triad of RCC symptoms?

Hematuria
Flank mass
Flank pain

35

What does a radical nephrectomy consists of?

Perifascial resection of:
- the kidney
- perirenal fat
- regional LN
- ipsilateral adrenal gland

Preferred treatment if the tumor extends into the inferior IVC

36

What are the methods of radical nephrectomy?

Open
Laparoscopic
Robotic surgical

Long-term outcomes indicate lap and open equivalent cancer-free survival rates

37

What does Sunitinib target?

Multi kinase inhibitor

Several receptor tyrosine kinases
- PDGFR-alpha and beta
- VEGFR 1, 2 and 3
- stem cell factor receptor (c-kit)
- FMS-like tyrosine insane (FLT-3)
- colony-stimulating factor (CSF-1R)
- Neuotrophic factor receptor (RET)

38

Tell me about the bio markers in RCC

None validated for general use in the prognostic/predictive assessment of RCC

PBRM1 mutations confer a favorable prognosis
BAP1 confer poor prognosis
Small proportion with PBRM1 + BAP1 mutations = worst survival

39

Options for T1 tumors (I.e.

Partial nephrectomy
Laparoscopic radical nephrectomy
RFA
Cryoablative treatments (3cm or less)
Active surveillance

40

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

41

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

42

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

43

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

44

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

45

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

46

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

47

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

48

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

49

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

50

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

51

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

52

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

53

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

54

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

55

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

56

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

57

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

58

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

59

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

60

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

61

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

62

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

63

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

64

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

65

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

66

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

67

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

68

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

69

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

70

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

71

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

72

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

73

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

74

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

75

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

76

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

77

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

78

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

79

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

80

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

81

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

82

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

83

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

84

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

85

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

86

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

87

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

88

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

89

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

90

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

91

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

92

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

93

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

94

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

95

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

96

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

97

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

98

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

99

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

100

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

101

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

102

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

103

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

104

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

105

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

106

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

107

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

108

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

109

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

110

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

111

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

112

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

113

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

114

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

115

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

116

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

117

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

118

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

119

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

120

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

121

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

122

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

123

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

124

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

125

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

126

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

127

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

128

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

129

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

130

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

131

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

132

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

133

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

134

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

135

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

136

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

137

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

138

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

139

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

140

What are the components of the MSKCC Criteria (2002)

LDH > 1.5 ULN
C.Ca > 2.5
Hb

141

Name some genetic aberrations

Papillary Type 1 tumors = activation of c-MET pathway

Papillary Type 2 tumors = inactivation of the Fumarate-hydratase Gene, Fumarate-accumulation and HIF1alpha up-regulation

Chromophobe RCC = mTOR