Register Now!







Release date: June 22, 2009
Expiration date: June 21, 2010
Program Description
Treatment options for patients with advanced renal cell carcinoma (RCC) have expanded significantly in recent years. In this CME-certified program, Dr. Robert Figlin and Dr. Gary Hudes discuss the emergence of targeted therapies for the treatment of patients with advanced RCC. Clinical trials have demonstrated the efficacy of five targeted agents in advanced RCC: sunitinib, sorafenib, bevacizumab, temsirolimus, and everolimus. This program will review the biology behind these agents, highlight their efficacy and safety in advanced RCC, and provide guidance in selecting the optimal therapy for each patient, based on their risk factors, treatment history, and other factors.

Target Audience
This activity has been designed for community oncologists and nurses who provide care and support to patients with advanced RCC.

Learning Objectives
After completing this activity, participants should be able to
  Describe the settings in which sunitinib, sorafenib, bevacizumab, temsirolimus, and everolimus have demonstrated a clinical benefit in patients with metastatic RCC
  Effectively choose an appropriate targeted therapy to optimize outcomes in patients with metastatic RCC
  Anticipate expected adverse events with targeted agents

Faculty
Robert A. Figlin, MD (Activity Director)
Arthur and Rosalie Kaplan Chair in Oncology
Professor and Chair, Medical Oncology and Therapeutics Research
City of Hope National Medical Center and Beckman Research Institute
Associate Director for Clinical Research
City of Hope National Medical Center
Duarte, California

Gary R. Hudes, MD
Director, Genitourinary Malignancies Program
Fox Chase Cancer Center
Philadelphia, Pennsylvania

Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the City of Hope and Alliance Medical Communications. The City of Hope is accredited by the ACCME to provide continuing medical education for physicians.

Designation of Credit
The City of Hope designates this educational activity for 1 AMA Physicians’ Recognition Award credit. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure
City of Hope takes responsibility for the content, quality and scientific integrity of this continuing medical education (CME) activity. Prior to their participation in this City of Hope CME activity, all faculty/presenters have disclosed any real or apparent vested commercial interest(s) in both those companies whose products may be discussed during the course of the activity and in those companies acting as commercial supporters of the activity. City of Hope further requires that prior to the activity, faculty/presenters have disclosed their intention to discuss any off-label and/or investigational (not yet approved for any purpose) use of pharmaceuticals or medical devices. Written disclosure of faculty/presenters’ specific commercial relationships and/or intent to discuss off-label and/or investigational is provided below.

Robert A. Figlin, MD (Activity Director)
Commercial Interest Relationship
Aveo Pharmaceuticals Consultant
Amgen, Argos Therapeutics, Antisoma plc,
Novartis AG; Pfizer Inc
Grant/Research Support

Gary R. Hudes, MD
Commercial Interest Relationship
Genentech; Novartis AG; Pfizer Inc; Wyeth Consultant
Pfizer Inc Speakers’ Bureau

Independent Clinical Peer Reviewer
Robert J. Morgan Jr., MD
Director, Continuing Medical Education
Associate Director for Education
Department of Oncology and Therapeutics Research
City of Hope National Medical Center
Duarte, California

Planning Committee
Crystal Saavedra, City of Hope National Medical Center and Deborah Dean, Mindy Tanzola, PhD, and Michelle Yechout, Alliance Medical Communications: No relevant financial relationships with any commercial interests.

Off-label Use
The following is a list of specific mention of off-label and/or investigational use of products within all presentations.

Product Investigational and/or Off-Label Use
Bevacizumab Renal cell carcinoma
IFN-α Renal cell carcinoma

References
1. Abrams TJ, Lee LB, Murray LJ et al. SU11248 inhibits KIT and platelet-derived growth factor receptor beta in preclinical models of human small cell lung cancer. Mol Cancer Ther. 2003;2(5):471-478.
2. Affinitor® prescribing information. Accessed April 2009. Available at http://www.pharma.us.novartis.com/product/pi/pdf/afinitor.pdf.
3. Atkins M, Regan M, McDermott D, et al. Carbonic anyhydrase IX expression predicts outcome of interleukin 2 therapy for renal cancer. Clin Cancer Res. 2005;11:3714-3721.
4. Atkins MB, Hidalgo M, Stadler WM et al. Randomized phase II study of multiple dose levels of CCI-779, a novel mammalian target of rapamycin kinase inhibitor, in patients with advanced refractory renal cell carcinoma. J Clin Oncol. 2004;22(5):909-918.
5. Atkins MB. ASCO 2006 annual meeting, Plenary Session.
6. Avastin® prescribing information. Genentech, Inc. Accessed February, 2009. Available at http://www.gene.com/gene/products/information/pdf/avastin-prescribing.pdf.
7. Bukowski RM, Eisen T, Szczylik C et al. Final results of the randomized phase III trial of sorafenib in advanced renal cell carcinoma: Survival and biomarker analysis. 2007 ASCO Annual Meeting Proceedings Part I. J Clin Oncol. 2007;25(18S):5023.
8. Cho D, Signoretti S, Dabora S et al. Potential histologic and molecular predictors of response to temsirolimus in patients with advanced renal cell carcinoma. Clin Genitourin Cancer. 2007;5(6):379-385.
9. Choueiri TK, Vaziri SA, Rini BI et al. Use of Von-Hippel Lindau (VHL) mutation status to predict objective response to vascular endothelial growth factor (VEGF) -targeted therapy in metastatic renal cell carcinoma (RCC). 2007 ASCO Annual Meeting Proceedings Part I. J Clin Oncol. 2007;25(18S):5012.
10. Coppin C, Porzsolt F, Awa A et al. Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev. 2005;Jan 25(1):CD001425.
11. de Paulsen N, Brychzy A, Fournier MC, et al. Role of transforming growth factor-alpha in von Hippel--Lindau (VHL)(-/-) clear cell renal carcinoma cell proliferation: a possible mechanism coupling VHL tumor suppressor inactivation and tumorigenesis. Proc Natl Acad Sci U S A. 2001;98(4):1387-1392.
12. Escudier B, Eisen T, Stadler WM et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007;356(2):125-134.
13. Escudier B, Pluzanska A, Koralewski P et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet. 2007;370(9605):2103-2111.
14. Figlin RA, Hutson TE, Tomczak P, et al. Overall survival with sunitinib versus interferon (IFN)-alfa as first-line treatment of metastatic renal cell carcinoma (mRCC). 2008 Annual ASCO Meeting Proceedings. J Clin Oncol. 2008;26(May 20 suppl):5024.
15. Fisher RI, Rosenberg SA, Fyfe G. Long-term survival update for high-dose recombinant interleukin-2 in patients with renal cell carcinoma. Cancer J Sci Am. 2000;6(Supplement 1):S55-S57.
16. George DJ, Michaelson MD, Rosenberg JE et al. Phase II trial of sunitinib in bevacizumab-refractory metastatic renal cell carcinoma (mRCC): Updated results and analysis of circulating biomarkers. ASCO Annual Meeting Proceedings Part I. J Clin Oncol. 2007;25(18S):5035.
17. Hicklin DJ, Ellis LM. Role of the vascular endothelial growth factor pathway in tumor growth and angiogenesis. J Clin Oncol. 2005;23(5):1011-1027.
18. Hudes G, Carducci M, Tomczak P et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356(22):2271-2281.
19. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71-96.
20. Kay A, Motzer R, Figlin R et al. Updated data from a phase III randomized trial of everolimus (RAD001) versus PBO in metastatic renal cell carcinoma (mRCC). 2009 ASCO Genitourinary Cancers Symposium. Abstract 278.
21. Latif F, Tory K, Gnarra J et al. Identification of the von Hippel-Lindau disease tumor suppressor gene. Science. 1993;260(5112):1317-1320.
22. Motzer RJ, Escudier B, Oudard S, et al. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet. 2008;372(9637):449-456.
23. Motzer RJ, Hutson TE, Tomczak P et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356(2):115-124.
24. Motzer RJ, Michaelson MD, Redman BG et al. Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol. 2006;24(1):16-24.
25. National Cancer Institute. SEER Cancer Statistics Fact Sheet: Cancer of the Kidney and Renal Pelvis. Accessed January, 2009, at http://seer.cancer.gov/statfacts/html/kidrp.html?statfacts_page=kidrp.html&x=16&y=22.
26. NCCN Practice Guidelines in Oncology. Kidney Cancer. v.1.2009. Accessed February, 2009. Available at http://www.nccn.org/professionals/physician_gls/PDF/kidney.pdf.
27. Nexavar® prescribing information. Accessed February, 2009. Available at http://berlex.bayerhealthcare.com/html/products/pi/Nexavar_PI.pdf.
28. Pantuck AJ, Trinh Q, Karakiewicz PI et al. Use of carbonic anhydrase IX (CAIX) expression and Von Hippel Lindau (VHL) gene mutation status to predict survival in renal cell carcinoma. ASCO Annual Meeting Proceedings Part I. J Clin Oncol. 2007;25(18S):5042.
29. Presta LG, Chen H, O'Connor SJ, et al. Humanization of an anti-vascular endothelial growth factor monoclonal antibody for the therapy of solid tumors and other disorders. Cancer Research. 1997;57(20):4593-4599.
30. Rini BI, Halabi S, Rosenberg JE et al. Bevacizumab plus interferon alfa compared with interferon alfa monotherapy in patients with metastatic renal cell carcinoma: CALGB 90206. J Clin Oncol. 2008;26(33):5422-5428.
31. Rini BI, Hutson TE, Elson P et al. A prospective trial of sorafenib in patients (pts) with metastatic clear cell renal cell carcinoma (mccRCC) refractory to prior sunitinib or bevacizumab. 2008 ASCO Genitourinary Cancers Symposium, Abstract 346.
32. Rini BI, Small EJ. Biology and clinical development of vascular endothelial growth factor-targeted therapy in renal cell carcinoma. J Clin Oncol. 2005;23(5):1028-1043.
33. Rosenberg JE, Motzer RJ, Michaelson MD et al. Sunitinib therapy for patients (pts) with metastatic renal cell carcinoma (mRCC): Updated results of two phase II trials and prognostic factor analysis for survival. 2007 ASCO Annual Meeting Proceedings Part I. J Clin Oncol. 2007;25(18S):5095.
34. Sablin MP, Bouaita L, Balleyguier C. et al. Sequential use of sorafenib and sunitinib in renal cancer: Retrospective analysis in 90 patients. ASCO Annual Meeting Proceedings Part I. J Clin Oncol. 2007;25(18S):5038.
35. Schwarzberg T, Regan MM, Liu L et al. Retrospective analysis of interleukin-2 therapy in patients with metastatic renal cell carcinoma who had received prior antiangiogenic therapy. J Clin Oncol. 2008;26:5044.
36. Snow RM, Schellhammer PF. Spontaneous regression of metastatic renal cell carcinoma. Urology. 1982;20(2):177-181.
37. Stadler WM. Targeted agents for the treatment of advanced renal cell carcinoma. Cancer. 2005;104:2323-2333.
38. Sutent® prescribing information. Accessed February, 2009. Available at http://www.pfizer.com/files/products/uspi_sutent.pdf.
39. Szczylik C, Demkow T, Staehler M et al. Randomized phase II trial of first-line treatment with sorafenib versus interferon in patients with advanced renal cell carcinoma: Final results. 2007 ASCO Annual Meeting Proceedings Part I. J Clin Oncol. 2007;25(18S):5025.
40. Tamaskar I, Garcia JA, Elson P et al. Antitumor effects of sunitinib or sorafenib in patients with metastatic renal cell carcinoma who received prior antiangiogenic therapy. J Urol. 2008;179(1):81-86; discussion 86.
41. Torisel® prescribing information, accessed February 2009. Available at http://www.wyeth.com/hcp/torisel/prescribing-information.
42. Upton MP, Parker RA, Youmans A et al. Histologic predictors of renal cell carcinoma response to interleukin-2-based therapy. J Immunother. 2005;28(5):488-495.
43. Wilhelm SM, Carter C, Tang L et al. BAY 43-9006 exhibits broad spectrum oral antitumor activity and targets the RAF/MEK/ERK pathway and receptor tyrosine kinases involved in tumor progression and angiogenesis. Cancer Research. 2004;64(19):7099-7109.
44. Wood L, Bukowski RM, Dreicer R et al. Temsirolimus (TEM) in metastatic renal cell carcinoma (mRCC): Safety and efficacy in patients (pts) previously treated with VEGF-targeted therapy. ASCO 2008 Genitourinary Cancers Symposium. Abstract 353.
45. Yang JC, Haworth L, Sherry RM et al. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med. 2003;349(5):427-434.
46. Yang JC, Sherry RM, Steinberg SM et al. Randomized study of high-dose and low-dose interleukin-2 in patients with metastatic renal cancer. J Clin Oncol. 2003;21(16):3127-3132.