Program DescriptionIn this CME-certified program, Dr. Michael Atkins will discuss the optimal use of systemic therapies in patients with metastatic renal cell carcinoma (RCC). Multiple targeted agents; including sunitinib, sorafenib, bevacizumab, and temsirolimus; have demonstrated a clinical benefit in various settings of metastatic RCC. For example, temsirolimus is particularly effective in poor-prognosis patients, sorafenib has demonstrated efficacy in the second-line setting, and bevacizumab is active in combination with interferon-α. Recent and ongoing clinical trials are attempting to optimize the use of these agents, while minimizing toxicities, through effective combinations and sequences. In his discussion, Dr. Atkins will provide the clinical context for these important data.
Target Audience
This activity will be 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 settings in which various targeted agents have demonstrated a clinical benefit in patients with metastatic RCC |
| |
• |
More effectively combine systemic therapies for patients with metastatic RCC |
| |
• |
Improve outcomes in patients with metastatic RCC through effective sequencing of systemic therapies |
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
Beth Israel Deaconess Medical Center
Leader, Kidney Cancer Program
Dana-Farber Harvard Cancer Center
Professor, Department 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 use of products 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 |
| Axitinib |
Renal cell carcinoma |
| Bevacizumab |
Renal cell carcinoma |
| Erlotinib |
Renal cell carcinoma |
| Everolimus (RAD001) |
Renal cell carcinoma |
| IFN-α |
Renal cell carcinoma |
References
| 1. |
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;22:909-918. |
| 2. |
Atkins M, Regan M, McDermott D, et al. Carbonic anhydrase IX expression predicts outcome of interleukin 2 therapy for renal cancer. Clin Cancer Res. 2005;11(10):3714-3721. |
| 3. |
Bracarda S, Porta C, Boni C. Randomized prospective phase II trial of two schedules of sorafenib daily and interferon-α2a (IFN) in metastatic renal cell carcinoma (RAPSODY): GOIRC Study 0681. J Clin Oncol. 2007;25(18S):5100. |
| 4. |
Bukowski RM, Kabbinavar F, Figlin RA, et al. Randomized phase II study of erlotinib combined with bevacizumab compared with bevacizumab alone in metastatic renal cell cancer. J Clin Oncol. 2007;25:4536-4541. |
| 5. |
Cho D, Signoretti S, Regan M, et al. The role of mammalian target of rapamycin inhibitors in the treatment of advanced renal cancer. Clin Cancer Res. 2007;13(2 Pt 2):758s-763s. |
| 6. |
Coppin C, Porzsolt F, Awa A et al. Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev. 2005;(1):CD001425. |
| 7. |
Escudier B. Advanced renal cell carcinoma: current and emerging management strategies. Drugs. 2007;67(9):1257-1264. |
| 8. |
Escudier B, Eisen T, Stadler WM. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007;356:125-134. |
| 9. |
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. |
| 10. |
Feldman DR, Kondagunta GV, Ronnen EA, et al. Phase I trial of bevacizumab plus sunitinib in patients (pts) with metastatic renal cell carcinoma (mRCC). J Clin Oncol. 2007;25(18S):5099. |
| 11. |
Figlin RA. Newly approved therapies for RCC and their effect on the standard of care. Clin Adv Hematol Oncol. 2007;5(1):35-36, 66. |
| 12. |
Garcia JA, Cooney MM, Mekhail T, et al. Sunitinib and bevacizumab in advanced solid tumors: Preliminary results of a phase I trial. ASCO 2008 Genitourinary Cancers Symposium. Abstract 352. |
| 13. |
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. J Clin Oncol. 2007;25(18S):5035. |
| 14. |
Gollob JA, Rathmell WK, Richmond TM, et al. Phase II trial of sorafenib plus interferon alfa-2b as first- or second-line therapy in patients with metastatic renal cell cancer. J Clin Oncol. 2007;25(22):3288-3295. |
| 15. |
Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356:2271-2281. |
| 16. |
Jonasch E, Corn P, Ashe RG, et al. Randomized phase II study of sorafenib with or without low-dose IFN in patients with metastatic renal cell carcinoma. J Clin Oncol. 2007;25(18S):5104. |
| 17. |
Kondagunta GV, Hudes GR, Figlin R, et al. Sunitinib malate (SU) plus interferon (IFN) in first line metastatic renal cell cancer (mRCC): Results of a dose-finding study. J Clin Oncol. 2007;25(18S):5101. |
| 18. |
Merchan JR, Liu G, Fitch T. Phase I/II trial of CCI-779 and bevacizumab in stage IV renal cell carcinoma: Phase I safety and activity results. J Clin Oncol. 2007;25(18S):5034. |
| 19. |
Motzer RJ, Escudier B, Oudard S, et al. RAD001 vs placebo in patients with metastatic renal cell carcinoma (RCC) after progression on VEGFr-TKI therapy: Results from a randomized, double-blind, multicenter Phase-III study. J Clin Oncol. 2008;26(May 20 suppl): Abstract LBA5026. |
| 20. |
Motzer RJ, Hutson TE, Tomczak P, et al. Phase III randomized trial of sunitinib malate (SU11248) versus interferon-alfa (IFN-α) as first-line systemic therapy for patients with metastatic renal cell carcinoma (mRCC). J Clin Oncol. 2006;24(18S):LBA3. |
| 21. |
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. |
| 22. |
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. |
| 23. |
Motzer RJ, Rini BI, Bukowski RM, et al. Sunitinib in patients with metastatic renal cell carcinoma. JAMA. 2006;295:2516-2524. |
| 24. |
Ratain MJ, Eisen T, Stadler WM, et al. Phase II placebo-controlled randomized discontinuation trial of sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol. 2006;24:2505-2512. |
| 25. |
Rini BI, Halabi S, Rosenberg JE, et al. CALGB 90206: A phase III trial of bevacizumab plus interferon-alpha versus interferon-alpha monotherapy in metastatic renal cell carcinoma. 2008 ASCO Genitourinary Cancers Symposium. Abstract 350. |
| 26. |
Rini BI, Wilding GT, Hudes G, et al. Axitinib (AG-013736; AG) in patients (pts) with metastatic renal cell cancer (RCC) refractory to sorafenib. J Clin Oncol. 2007;25(18S):5032. |
| 27. |
Rosenberg JE, Weinberg VK, Claros C, et al. Phase I study of sorafenib and RAD001 for metastatic clear cell renal cell carcinoma. J Clin Oncol. 2008;26(May 20 suppl):5109. |
| 28. |
Ryan CW, Goldman BH, Lara PN Jr, et al. Sorafenib with interferon alfa-2b as first-line treatment of advanced renal carcinoma: a phase II study of the Southwest Oncology Group. J Clin Oncol. 20071;25(22):3296-301. |
| 29. |
Sablin MP, Bouaita L, Balleyguier C, et al. Sequential use of sorafenib and sunitinib in renal cancer: Retrospective analysis in 90 patients. J Clin Oncol. 2007;25(18S):5038. |
| 30. |
Schwarzberg T, Regan MM, Liu V, 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(May 20 suppl): Abstract 5044. |
| 31. |
Sosman JA, Flaherty KT, Atkins MB. Updated results of phase I trial of sorafenib (S) and bevacizumab (B) in patients with metastatic renal cell cancer (mRCC). J Clin Oncol. 2008;26(May 20 Suppl): Abstract 5011. |
| 32. |
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. |
| 33. |
Whorf RC, Hainsworth JD, Spigel DR, et al. Phase II study of bevacizumab and everolimus (RAD001) in the treatment of advanced renal cell carcinoma (RCC). J Clin Oncol. 2008;26(May 20 Suppl): Abstract 5010. |
| 34. |
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;349:427-434. |
Top of the Page>>
|
