For patients with metastatic renal cell carcinoma (mRCC), oral therapy has improved outcomes and has become a standard of care. When selecting oral therapies for mRCC, an important consideration is how well patients can tolerate optimal dosing of a particular agent.2 As Robert A. Figlin, MD, FACP, noted in an article published in the August 2013 issue of Physician’s Weekly—Oncology Edition, a key goal when initiating oral therapy in mRCC patients is to maintain the starting dose throughout the treatment course when possible.
Outside of a clinical trial setting, the application of oral therapies may present some challenges when treating mRCC patients with unique needs.1 For example, some patients may be more prone than others to experience potential drug interactions or to have comorbidities that can affect how patients are managed with oral therapy.
Prior to initiating oral therapy, clinicians should educate patients about the potential treatment-related adverse reactions (ARs). Patients should be made aware that some ARs, but not all, may be manageable during their treatment. Oral therapies have been shown to have serious life-threatening side effects, in addition to low-grade ARs.
Dosing regimens of oral therapy for mRCC might need to be adjusted based on individual safety and tolerability.1
When to Consider Dose Modifications or Interruptions
Currently, there are no data that directly compare the relative safety and tolerability of oral therapies for mRCC.2 As a result, clinicians must rely on data provided from published studies of randomized controlled trials involving available agents, dosing recommendations in the package insert information, and their own clinical experience.1
In some patients, dose modifications or interruptions may be considered when managing treatment-related ARs. Other possible reasons for adjusting dose include comorbidities, co-medications, and food interactions. Each oral therapy is associated with its own unique toxicity profile, meaning that dose modifications and adjustments may vary from drug to drug. In support of patient adherence, clinicians should employ strategies to help manage ARs.
Factors to Assess at Each Visit
To optimize treatment of mRCC with oral therapies, clinicians must proactively monitor patients at each visit for ARs, comorbidities, and difficulties with drug adherence. A multidisciplinary team approach should be used to optimize the patient experience. If a dose adjustment is necessary, the goal should be to do so while maintaining maximum drug efficacy without increasing toxicity. With early intervention and appropriate management of side effects, when possible, clinicians can increase their likelihood of helping patients avoid unnecessary dose reductions, interruptions, or even early treatment discontinuation.1
1. Hutson TE, Figlin RA, Kuhn JG, Motzer RJ. Targeted therapies for metastatic renal cell carcinoma: an overview of toxicity and dosing strategies. Oncologist. 2008;13:1084–1096. Available at: http://theoncologist.alphamedpress.org/content/13/10/1084.long.
2. Eisen T, Sternberg CN, Robert C, et al. Targeted therapies for renal cell carcinoma: review of adverse event management strategies. J Natl Cancer Inst. 2012;104:93-113. Available at: http://jnci.oxfordjournals.org/content/104/2/93.full.pdf+html.