Program Description

In this CME-Certified presentation, Dr. Michael Atkins will review the use of cytokines for the treatment of advanced renal cell carcinoma. Clinical trials indicate that while most patients do not respond to high-dose IL-2, a small proportion of patients achieve durable complete responses. Efforts to identify predictive factors associated with responses to cytokine therapy are discussed. The module will also review the benefit of adding nephrectomy, and, more recently, targeted agents to enhance the efficacy of cytokine therapy.

Target Audience
This activity has been designed for community-and hospital-based medical oncologists, hematologists, urologists, nephrologists, and allied healthcare providers who provide medical care and support to patients with renal cell carcinoma.

Learning Objectives
After completing this program, participants should be able to
  Describe the application of cytokine therapy in metastatic RCC
  Discuss the role of cytokines in the era of targeted therapy for metastatic RCC
  Select optimal patients for cytokine therapy in metastatic RCC

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 Comprehensive Cancer Center
Duarte, California

Michael B. Atkins, MD
Deputy Chief, Division of Hematology/Oncology
Director of Biologic Therapy and Cutaneous Oncology Programs
Director, Cancer Clinical Trials Office
Associate Director for Clinical Research
Beth Israel Deaconess Medical Center
Leader, Kidney Cancer Program
Dana-Farber/Harvard Cancer Center
Professor of Medicine
Harvard Medical School
Boston, Massachusetts

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
This activity is designated for .5 AMA Physicians’ Recognition Award™ credits. To receive your CME credits you are requested to review the material in full and take the post-test and evaluation. Your evaluation of the activity and comments will remain confidential.

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
Amgen, GlaxoSmithKline plc; Keryx
Biopharmaceuticals, Inc.; Pfizer Inc; Wyeth
Grant/Research Support
Keryx Biopharmaceuticals, Inc; Pfizer Inc;
Wyeth
Consultant

Michael B. Atkins, MD
Commercial Interest Relationship
Novartis AG Grant/Research Support
Antigenics Inc.; Aveo Pharmaceuticals, Inc.;
Bayer Healthcare AG; Genentech, Inc.;
Novartis AG; Onyx Pharmaceuticals, Inc.;
Pfizer Inc; Wyeth
Consultant

Dr. Atkins reported the following specific mention of off-label and/or investigational use of products within his presentation.

Product Investigational and/or Off-Label Use
Bevacizumab Renal cell carcinoma
IL-2 Renal cell carcinoma
IFN-α & IFN-α-2a Renal cell carcinoma
MPA (medroxyprogesterone acetate) Renal cell carcinoma
Sorafenib Renal cell carcinoma

References
1. Arzpodien J, Korfer A, Franks CR, Poliwoda H, Kirchner H. Home therapy with recombinant interleukin-2 and interferon-α-2b in advanced human malignancies. Lancet. 1990;335:1509-1512.
2. 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;370:2103-2111.
3. Fisher RJ, Rosenberg SA, Fyfe G. Long-term survival update for high-dose recombinant interleukin-2 in patients with renal cell carcinoma. J Sci Am. 2000;6:Suppl 1:S55-S57.
4. Interferon-alfa and survival in metastatic renal carcinoma: early results of a randomised controlled trial. Medical Research Council Renal Cancer Collaborators. Lancet. 1999;353:14-17.
5. McDermott DF, Regan MM, Clark JI, et al. Randomized phase III trial of high-dose interleukin-2 versus subcutaneous interleukin-2 and interferon in patients with metastatic renal cell carcinoma. J Clin Oncol. 2005;23:133-141.
6. Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356:115-124.
7. National Comprehensive Cancer Network. "Kidney Cancer." NCCN Clinical Practice Guidelines in Oncology 2007;v.1.2008.
8. Negrier S, Escudier B, Lasset C, et al. Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. N Engl J Med. 1998;338:1272-1278.
9. Pantuck AJ, Belldegrun AS, Figlin RA. Nephrectomy and interleukin-2 for metastatic renal-cell carcinoma. N Engl J Med. 2001;354:1711-1712.
10. Rosenberg SA, Lotze MT, Muul LM, et al. A progress report on the treatment of 157 patients with advanced cancer using lymphokine-activated killer cells and interleukin-2 or high-dose interleukin-2 alone. N Engl J Med. 1987;316:889-897.
11. Rosenberg SA, Lotze MT, Muul LM, et al. Observations on the systemic administration of autologous lymphokine-activated killer cells and recombinant interleukin-2 to patients with metastatic cancer. N Engl J Med. 1985;313:1485-1492.
12. West WH, Tauer KW, Yannelli JR, et al. Constant-infusion recombinant interleukin-2 in adoptive immunotherapy of advanced cancer. N Engl J Med. 1987;316:889-897.
13. 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;21:3127-3132.

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