34 Kidney Cancer Journal T A B L E O F C O N T E N T S Following the Foot Prints Left by ASCO 2017: Reflections and Observations s the ASCO Scientific Sessions of 2017 recede on our calendars, what will be our “take-home” messages? Will we see these sessions in much the same way we view objects in the rear view mirror of our vehicle, as “closer than they actually appear”? In other words, we might speculate as to how close we are to approaching the time when trends observed at ASCO actually have translational impact on our practices. Much of this is already happening, so don’t look now, but your practice is changing as we speak, and what we see retrospectively from ASCO is already having a sharp impact on how we treat RCC. Here are some quick snapshots from the meeting and general observations: Adjuvant therapy. We know that a recent New England Journal of Medicine article demonstrated that sunitinib prolongs progression-free survival (PFS) when compared to placebo in high risk, resected patients. The PROTECT trial, as reported at ASCO demonstrated the intent-to-treat analysis was negative but patients who received pazopanib at full doses showed a hazard ratio significantly less than placebo. This suggests that we may need to give targeted agents at full doses in the adjuvant setting to achieve the full impact. Landscape of treatment. We have a series of drugs available for sequencing— there are TKIs, followed by immune-oncology (IO). Clearly, there are trials that continue to change the landscape. For example, CABOSUN is a trial that compared cabozantinib and sunitinib in the frontline setting with some demonstrated benefit with respect to PFS and OS. If cabozantinib receives regulatory approval, that might change the landscape. The upfront IO combinations or IOs and targeted therapies as illustrated at the 2017 ASCO meeting will be the kinds of trials that will change the landscape in the future. Immuno-oncology. As we understand the interaction between cancer and the immune system, we recognize that single checkpoint inhibitors have great efficacy, but probably combinations are better, whether it’s IO-IO, or IO and targeted therapy or IO and a novel therapy. In 5 years we will look back and say that the 1990s and 2000s were the era of targeted therapy, but beyond that we are likely to say that IOs are a better replacement. Sequencing of therapy. In the frontline, the targeted agent could be pazopanib or sunitinib or a clinical trial. In the second line we have much controversy because we have a series of drugs, many of which have demonstrated both progression-free and overall survival benefits compared to mTOR inhibitors but have never been compared to each other. In my practice, I tend to use nivolumab first as the second line therapy because I am trying to obtain that tail of the curve and an improvement in overall survival. I reserve agents like cabozantinib and everolimus but that may change depending on how the Editorial Mission The purpose of Kidney Cancer Journal is to serve as a comprehensive resource of information for physicians regarding advances in the diagnosis and treatment of renal cell carcinoma. Content of the journal focuses on the impact of translational research in oncology and urology and also provides a forum for cancer patient advocacy. Kidney Cancer Journal is circulated to medical oncologists, hematologist-oncologists, and urologists. Editor-in-Chief Robert A. Figlin, MD, FACP Steven Spielberg Family Chair in Hematology Oncology Professor of Medicine and Biomedical Sciences Director, Division of Hematology Oncology Deputy Director, Samuel Oschin Comprehensive Cancer Institute Cedars-Sinai Medical Center Medical Advisory Board Michael B. Atkins, MD Deputy Director Lombardi Comprehensive Cancer Center Professor of Oncology and Medicine, Georgetown University Medical Center Washington, DC Ronald M. Bukowski, MD Emeritus Staff & Consultant CCF Taussig Cancer Center Professor of Medicine CCF Lerner College of Medicine of CWRU Cleveland, Ohio Robert J. Motzer, MD Attending Physician Memorial Sloan-Kettering Cancer Center New York, NY Christopher G. Wood, MD, FACS Douglas E. Johnson, MD Professorship Professor & Deputy Chairman Department of Urology M.D. Anderson Cancer Center Houston, Texas Nurse Advisory Board Nancy Moldawer, RN, MSN Nursing Director Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute Los Angeles, California Laura Wood, RN, MSN, OCN Renal Cancer Research Coordinator Cleveland Clinic Taussig Cancer Center Cleveland, Ohio Patient Advocate William P. Bro Chief Executive Officer Kidney Cancer Association Publishing Staff Stu Chapman, Executive Editor Jenny Chapman, Director, Business Development Gloria Catalano, Production Director Michael McClain, Design Director Business and Administration Office 515 E. 88th Street, Suite 1L New York, N Y 10128 Editorial Offices Genitourinary Publishing 2557 Tulip Street Sarasota, FL 34239 Tel: (516) 356-5006 © Copyright 2016 Genitourinary Publishing. All rights reserved. None of the contents may be reproduced in any form without the permission of the publisher. About the Cover A broad spectrum of toxicities may be associated with various treatments for renal cell carcinoma. The figures in this illustration represent possible multi-organ involvement and potential adverse reactions related to treatments that include immunotherapy and targeted therapy. Reports in this issue suggest how these toxicities can be managed and the safety profile of agents can be optimized. (Copyright ©, Carol and Mike Werner / Science Source) 36 Journal Club 37 Medical Intelligence 38 Optimizing the Safety Profile of Immune Checkpoint Blockade in Renal Cell Carcinoma 44 Cardiovascular Events and Torsades de Pointes in Patients Using Pazopanib and Other Marketed Anti-VEGF Agents for Metastatic Renal Cell Carcinoma: A Descriptive Study 49 Case Report: Sunitinib and Zoledronic Acid Combination Therapy for Metastatic Renal Cell Carcinoma: Alarming for Osteonecrosis of the Jaw 53 Highlights from the ASCO 2017 Scientific Sessions E D I TOR ’ S M E M O (continued on page 51) A
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