35. Haddad AQ, Leibovich BC, Abel EJ, et al. Preoperative multivariable prognostic models for prediction of survival and major complications following survival resection of renal cell carcinoma with suprahepatic caval tumor thrombus. Urol Oncol. 2015;33;388:e1-9. 36.ClinicalTrials.gov. NCT02473536. 37. Taunk NK, Spratt DE, Bilsky M, et al. Spine radiosurgery in the management of renal cell carcinoma metastases. J Nat Compreh Can Network. 2015;13:801-809. 38. Taunk NK, Spratt DE, Bilsky M, et al. Spine radiosurgery in the management of renal cell carcinoma metastases. J Nat Compreh Can Network. 2015;13:801-809. 39. Alt AL1, Boorjian SA, Lohse CM, Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer. 2011; 117:2873-2882. 40. Svedman C, Sandstrom P, Pia P, et al. A prospective Phase II trial of 80 Kidney Cancer Journal using extracranial stereotactic radiotherapy in primary and metastatic renal cell carcinoma. Acta Oncologica. 2006;45:870-875. 41. Camphausen K, Moses MA, Menard C, Sproull M, Beecken WD, Folkman J, et al. Radiation abscopal antitumor effect is mediated through p53. Cancer Res. 2003;63(8):1990-1993. 42.Gerlinger M, Rowan AJ, Horswell S, et al. Intratumor heterogeneity and branched evolution revealed by multiregion sequecning. N Engl J Med. 2012;36:883-892. 43. Straka C1, Kim DW, Timmerman RD, et al. Ablation of a site of progression with stereotactic body radiation therapy extends sunitinib treatment from 14 to 22 months. J Clin Oncol. 2013 Aug 10;31(23): e401-3. 44. CliicalTrials.gov. NCT020195766. KCJ while limiting the adverse effects that often stand in the way of continuing with the 4 weeks on and 2 weeks off strategy. So here, too, an intriguing and significant evolution in the standard of care is taking place with regards to the relative merits of the 4/2 dosing schedule vs the 2/1 schedule. The particularly interesting aspect of this evolution is the apparent initiative on the part of many of our colleagues in community practice to stay ahead of the curve or integrate novel approaches that enable them to prolong exposure to sunitinib or at least mitigate the impact of adverse effects through various drug-free interval strategies. There are skeptics, however, who may ask whether it is appropriate to expend more resources prospectively testing (data we need to verify appropriate dosing schedules) a new schedule of an older targeted agent in lieu of the excitement over the latest generation of immune-oncologics in RCC. There are two reasons for continuing to investigate VEGF blockade in this context. First, not all RCCs respond to immunotherapy, as Lauren C. Harshman, MD reminds us in an Editorial in the Journal of Clinical Oncology (2017;35(16) 1755-1757. This is true of even the modern and more tolerable PD-1 pathway antibodies. Also, VEGF-pathway blockade remains the backbone of many ongoing, first-line PD-1 combination studies. These considerations remain essential in view of the new agents recently approved and the implications for the treatment paradigm. The article in this issue by Pavlos Msaouel, MD, and Nizar Tannir, MD, not only delineates these issues but suggests state-of-the-art thinking on tailoring sunitinib schedules to achieve maximum benefit. Bernard J. Escudier, MD Guest Editor EDITOR’S MEMO (continued from page 62)
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