Treatment of patients with metastatic renal cell cancer

Abstract

BACKGROUND.New developments in the treatment of patients with metastatic renal cell cancer (MRCC) have suggested a need to reevaluate the role of systemic therapies. The authors convened a panel of medical and urologic oncologists to rate the appropriateness of the main options.METHODS.The authors used the RAND/University of California‐Los Angeles Appropriateness Method to evaluate systemic therapy options and cytoreductive nephrectomy. After a comprehensive literature review, an expert panel rated the appropriateness of systemic options (108 permutations) and cytoreductive nephrectomy (24 permutations) for patients with MRCC.RESULTS.The appropriateness evaluation indicated that 27.3% of permutations were rated “appropriate,” 46.9% were rated “inappropriate,” and 25.8% were rated “uncertain.” There was a high rate of agreement (95%). Sunitinib and sorafenib were rated appropriate for patients with low‐to‐moderate risk regardless of prior treatment. Temsirolimus was rated appropriate for first‐line therapy for higher risk patients. Interferon‐α and low‐dose interleukin‐2 were rated inappropriate or uncertain. In patients who received prior immunotherapy, cytokines were rated inappropriate. In all permutations for evaluating systemic therapy, enrollment into an investigational trial was considered appropriate, treatment with bevacizumab was uncertain, and thalidomide was inappropriate regardless of risk status or prior therapy. For good surgical risk patients with planned immunotherapy, nephrectomy was rated appropriate in patients who had limited metastatic burden regardless of tumor‐related symptoms and in symptomatic patients regardless of metastatic burden. Only the most favorable combination of surgical risk, metastatic burden, and symptoms generated an “appropriate” rating for patients with planned targeted therapy.CONCLUSIONS.The current results begin the process of defining an appropriate role for cytokines, newer targeted therapies, and surgery in the treatment of MRCC. Cancer 2006. © 2006 American Cancer Society.

Appropriateness of Treatments for Patients With Degenerative Ataxias: Recommendations by a Panel of Experts

“…The rate of inappropriate recommendations in this study is high, confirming that whereas high quality scientific evidence are most often helpful in illuminating what clinicians should do in practice, expert opinion help to determine what they should not do and can delineate uncertain indications for which new trials are needed. Surprisingly the percentage of uncertain pairs, which could be interpreted as an expression of the lack of information and/or clinical experience, is not higher than the observed results published for other consensus panels on chronic and frequent diseases or common procedures [12,15,16]. In our case, since there was no disagreement among the panelists, these uncertain indications are due to median scores in the 4 -6 range.…”

Vaccination of Renal Cell Cancer Patients with Modified Vaccinia Ankara Delivering Tumor Antigen 5T4 (TroVax) Administered with Interleukin 2: A Phase II Trial

“…Previous studies in renal cell carcinoma patients treated with low dose IL-2 regimens in the first line setting have reported response rates ranging from 6% to 23% (16). Despite being heavily pretreated and containing a large proportion of patients with non -clear cell histologies, the objective response rate (12%) and relatively high frequency of complete responses were surprising, and the survival data, although immature, are encouraging.…”

KANSER TEDAVİSİNDE mTOR İNHİBİTÖRLERİ

“…Bu nedenle kötü prognozlu metastatik böbrek hücreli kanserin birinci basamak tedavisinde kullanılmaktadır (29). Ancak elde edilen verilerin yeterli olmaması sebebiyle temsirolimus tedavisi daha önce immünoterapi uygulanmış hastalarda ise değerlendirilememektedir (41). Avrupa Birliği İlaç Ajansı (EMEA) tarafından 6 Nisan 2006' da en az 6 prognostik risk faktörü olan ilerlemiş renal hücre kanserinin birinci sıra tedavisi için onaylanmıştır.…”