#renalcell — Public Fediverse posts

❄️ 1 hour until TONIGHT'S #TumorBoardTuesday!!

❄️ @shilpaonc takes us through treating clear cell #RenalCellCarcinoma

❄️ Snag some hot chocolate (+Bailey’s 😉), grab a blanket, and prepare your 🧠 with these #CME👇🏽See you soon!

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RT @TumorBoardTues
#TumorBoardTuesday #PreTest❓Free #CME🔗: http://integrityce.com/tbt

🤔B4⃣ @shilpaonc🗣️management of #RenalCell🦀, test your🧠with these 2❓s:

Q1⃣: What Tx would you choose for a PS=2 hom…
https://twitter.com/TumorBoardTues/status/1602811547075624961

17/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🔬Research needed to ⬇️ tox while maintaining efficacy

❓Alternative dosing strategies (incl. dose breaks)
❓Effects of dose ⬇️ on pt outcomes
❓Effects of reduced ▶️ dose on pt outcomes

16/#TumorBoardTuesday #RenalCell

If tox occurs,🔑strategy
🔸⬇️dose TKI
🔹Dose flex of TKIs>ICIs
🔸Axi fastest washout (hrs)

🔹Lenva 14mg➡️10mg ➡️8mg
🔸Axi 5mg➡️3mg➡️2mg
🔹Cabo 40mg QD➡️20mg QD➡️20mg QOD

Many pts need dose⬇️
BUT most can stay on tx if manage pt expectations

15/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🟢Pt w mRCC
🔸Initiated tx w pembro + lenva
🔹Developed G3 diarrhea
🔸Lenva withheld & anti-diarrheal treatment initiated 🔹Diarrhea now resolved.

🟢What next step is best for the pt?

14/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

Effective tox mgmt ➡️optimize pt outcomes✅

🩺 Mgmt strategies include...🩺
🔹Prevention
🔸Monitor BP, urine protein, thyroid & liver function
🔹Dose modification (⏸️⬇️🛑)
🔸Supportive care

13/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🔬Common tox in pivotal P3 #CHECKMATE214 trial of dual ICI combo🔬
🔸Fatigue
🔹Pruritus
🔸Diarrhea
🔹Rash
🔸Nausea

12/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🔬Common tox in pivotal Phase 3 trials of TKI-ICI combos🔬
#KEYNOTE426 #CLEAR #CHECKMATE9ER #JAVELINrenal101
🔹Diarrhea
🔸HTN
🔹Hypothyroidism
🔸Fatigue
🔹PPES
🔸Loss of appetite

11/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

Some AEs attributable to either drug
These🔂overlapping tox can complicate pt mgmt

10/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🟢Which of the following is an AE that is commonly observed with both ICIs and TKIs?

9/#TumorBoardTuesday #RenalCell
ICI AEs related to immunostimulatory MOA (irAEs)
✳️Most mild/mod severity & reversible
⚠️CAN become sev/fatal if not promptly Dx & Tx⚠️
👉Impact virtually any bodily system
🗓️Most occur “early” (<14wks after start tx), some can occur mos/yrs later

7/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🟢Which of the following is a characteristic feature of the most common toxicities associated with anti-angiogenic therapies?

8/#TumorBoardTuesday #BonumCE #RenalCell

Combo tx =possible⬆️tox➡️can lead to trtmnt🛑

✨Anti-angio inhibitors=multi🎯TKIs
✨AEs related to shared 🎯s (e.g. VEGFR)=predictable class tox
✨Some nuance due 2 diff🎯/potency
✨Typ occur 1st few wks of ▶️tx
✨Broadly dose-dependent

6/ #TumorBoardTuesday #BonumCE #OncTwitter #NephTwitter #MedTwitter #RenalCell

✳️Dual ICI combo (ipi + nivo) also approved tx option

💎#CheckMate214 - ipi + nivo vs sunitinib
✅Longest follow-up in frontline RCC (>5 years)
✅OS and PFS favor combo tx in int/poor risk pts

5/#TumorBoardTuesday #RenalCell
🔑Ph3 trls #KEYNOTE426, #CLEAR, #CheckMate9ER, #CheckMate214

💎Each combo regimen ⬆️PFS, OS, & ORR vs sunitinib
💎Axi-avelumab approved but OS data immature
💎Benefit across IMDC risk groups
💎Axi-pembro=longest f/u among approved TKI-ICI in RCC

4/ #TumorBoardTuesday #BonumCE #OncTwitter #RenalCell

💎Combo txs as SOC for 1st line mRCC💎

TKI/ICI combos:
🔸#lenvatinib (TKI) + #pembrolizumab (PD-1 mAb)
🔸#axitinib (TKI) + pembro
🔸#cabozantinib (TKI) + #nivolumab (PD-1 mAb)

Dual ICI combo:
🔸#ipilimumab (CTLA-4) + nivo

3/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🟢 Which of the following TKI/IO combo regimens is 🚫NOT approved by the FDA for the frontline mgmt of #RenalCell carcinoma?

2/ #TumorBoardTuesday #BonumCE #RenalCell #OncTwitter #NephTwitter
🆓#CME info ➕ full ref list🗒️ 👉 http://bit.ly/3VDaK81

✳️The critical elements👇

1/ #OncTwitter #NephTwitter #TumorBoardTuesday
✅#RenalCell #MedTweetorial🧵
w @brian_rini @shilpaonc @katy_beckermann

🦺TKI/IO safety data
🥽Tox to look 4
⛑AE mgmt

🆓#CME @BonumCe🔗http://bit.ly/3VDaK81
Support by edu grants from Eisai & @Merck

🟢What's your specialty?