Management of Metastatic Kidney Disease

Newswise — Dr. Brian Rini, M.D. moderated a session on Kidney Cancer titled "Management of Metastatic Disease" at the 8th Annual Meeting of the Society of Urologic Oncology (SUO).

The session consisted of several talks. Dr. McDermott presented "IL-2/Bevacizumab". He stated that INF-alpha was the historical de facto standard. Both sunitinib and temsirolimus were superior to INF-alpha in clinical trials, he said. Patient selection should incorporate histology, as non-clear cell histology does not benefit from IL-2. Even with clear cell, mixed histology with papillary type 2 or alveolar elements result in poor response to IL-2. A role for combination therapies is clinical study, and for example bevacizumab plus INF was superior to INF alone. However, prior TKI therapy may make cytokine therapy more dangerous.

Dr. Michael Atkins made a presentation on "TKI's". All targeted therapies are active in cytokine refractory patients and produce tumor shrinkage in 50-80% of patients. However, there are very few complete responses and continued therapy is required to maintain benefit. He presented an algorithm for therapy. For fist line therapy in good risk patients one should consider sunitinib, high-dose IL-2 or bevacizumab. In poor risk patients, temsirolimus is preferred. It is important to select therapies based upon biologic tumor characteristics rather than clinical features. For example, regarding temsirolimus pS6 and pAKT are biological selection markers, along with younger age and poor risk characteristics. The benefit was greater in the non-clear cell histology patients. High tumor pS6 or pAKT expression status appears necessary for response. The VHL mutation status predicts for response, especially for sorafenib and bevacizumab, but sunitinib is less dependent on VHL status. This potentially may account for increased response with sunitinib, as VHL wild type tumors have response.

Dr. Rini then presented "Systemic Therapy Sequences and Combinations that make Sense". He presented data on treating with sorafenib then sunitinib and visa-versa. The outcome is that there is activity to the second line agent, but no obvious sequence that emerges as superior. For example, sunitinib has a 23% partial response rate following bevacizumab therapy. He showed data that even third line therapy has partial response rates of 20-25%. A number of trials of sequential targeted agents are presently ongoing.

Reported by Christopher P. Evans, MD, a Contributing Editor with UroToday.com.

About UroTodayUroToday.com attracts more than 55,000 readers monthly. The website covers over 22 urology disease categories and provides the most in depth Urological conference reports available online. UroToday.com is the world leader in delivering a quality, global online publication providing accurate and timely education that is clinically relevant in the practice of Urology. All scientific content is developed by urologists committed to translating research into clinically relevant science, including all genitourinary cancers, pediatric and geriatric urological dysfunctions for urologists, medical oncologists, advanced nurse practitioners and other medical professionals.