Considerations for Dosing of Oral Therapies in Metastatic RCC

Considerations for Dosing of Oral Therapies in Metastatic RCC

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...

Metastatic Renal Cell Carcinoma Therapy: Supporting Patients

Data from the American Cancer Society estimate that 65,150 new cases of kidney cancer, including renal cell carcinoma (RCC), renal pelvis carcinoma, and Wilms tumor, are expected to be diagnosed in the United States in 2013.1 Kidney cancer is among the 10 most common cancers in both men and women. Approximately 90% of renal tumors are RCC, and 85% of these are clear cell tumors.2 From 2005 to 2009, kidney cancer incidence rates increased by 3.1% per year, primarily because of an increase in the detection of early stage disease. Most people with kidney and renal pelvis cancer are older when they are diagnosed (Figure),3 with the median age at diagnosis being about 65.2 An estimated 13,680 deaths from kidney cancer are expected to occur in 2013. Overall, the mortality rate for kidney cancer decreased by an average of 0.5% per year from 2005 to 2009.1 Recent estimates suggest that 20% to 30% of RCC patients present with metastatic disease.4 About 70% of RCC patients develop metastases during the course of their disease. The 5-year survival rate for patients with metastatic RCC (mRCC) is 11.6%, which is significantly lower than that of localized or regional RCC (Table).2 Treatment According to Robert A. Figlin, MD, FACP, interleukin-2 (IL-2) was the previous standard of care for mRCC in the 1990s. “While response rates were low, about half of mRCC patients who responded to IL-2 demonstrated long-term disease-free survival, and some of these patients were completely cured. However, the side effects associated with IL-2 were severe.” As clinician researchers have gained an improved understanding of the biology of kidney cancer, several targeted...