@TumorBoardTues 1/17 #TumorBoardTuesday #RenalCancer #OncTwitter
68yo👨🏾
HTN
T2DM
Arthritis
✂️2022: L Radical Nephrectomy
🔬Clear cell #RenalCellCarcinoma
📏8.2 cm, Grade 2, extends into renal vein (T3a)
❓No lymph nodes sampled (NX)
❌No other dz sites
What would you pick for adj therapy?
68yo👨🏾
HTN
T2DM
Arthritis
✂️2022: L Radical Nephrectomy
🔬Clear cell #RenalCellCarcinoma
📏8.2 cm, Grade 2, extends into renal vein (T3a)
❓No lymph nodes sampled (NX)
❌No other dz sites
What would you pick for adj therapy?
@TumorBoardTues 2/17 #TumorBoardTuesday #RCC
🚨There’s significant relapse risk in ≥ Stage II RCC even after local tx✂️
🔢We use tools like Fox Chase’s ASSURE Prognostic nomogram to estimate disease free survival (DFS)
📈Example for our pt below
📚Correa, Andres F cancernomograms.com/nomograms/492
🚨There’s significant relapse risk in ≥ Stage II RCC even after local tx✂️
🔢We use tools like Fox Chase’s ASSURE Prognostic nomogram to estimate disease free survival (DFS)
📈Example for our pt below
📚Correa, Andres F cancernomograms.com/nomograms/492
@TumorBoardTues 3/17 #TumorBoardTuesday @brian_rini
⭐RCC Adjuvant Therapy⭐
⚖️Weighing recurrence risk with a long list 📜 of adj trial results?
💉Focusing on adju IO & review:
✨KEYNOTE-564: Pembro
✨CheckMate 914: Nivo/Ipi
✨IMmotion010: Atezo
✨PROSPER: Periop Nivo
⭐RCC Adjuvant Therapy⭐
⚖️Weighing recurrence risk with a long list 📜 of adj trial results?
💉Focusing on adju IO & review:
✨KEYNOTE-564: Pembro
✨CheckMate 914: Nivo/Ipi
✨IMmotion010: Atezo
✨PROSPER: Periop Nivo
@TumorBoardTues @brian_rini 4/17 #TumorBoardTuesday
👨🏻🏫Mini tweetorial 1👨🏻🏫
Before adj IO, quick review
📌adj TKI
Main ➕ trial:
✨S-TRAC - Adj sunitinib vs placebo (2016)
🥳Improved DFS
🔢6.8 vs 5.6 yrs (HR 0.76, p=0.03)
👍FDA
🤔Why not offer adju TKI more?
☠️High tox rate &📉neg OS in addtl trials
👨🏻🏫Mini tweetorial 1👨🏻🏫
Before adj IO, quick review
📌adj TKI
Main ➕ trial:
✨S-TRAC - Adj sunitinib vs placebo (2016)
🥳Improved DFS
🔢6.8 vs 5.6 yrs (HR 0.76, p=0.03)
👍FDA
🤔Why not offer adju TKI more?
☠️High tox rate &📉neg OS in addtl trials
@TumorBoardTues @brian_rini 5/17 #TumorBoardTuesday
👨🏻🏫Mini tweetorial 2👨🏻🏫
Adj IO tx really took off🚀with:
✨KEYNOTE-564
⭐NEJM 2021 phase III trial
✂️Resected ccRCC
Stage II AND g4 or sarcomatoid
OR
≥ stage III
OR
Reg LN mets
OR
Stage M1 & NED
💉1 yr adj pembro vs placebo
nejm.org/doi/full/10.10…
👨🏻🏫Mini tweetorial 2👨🏻🏫
Adj IO tx really took off🚀with:
✨KEYNOTE-564
⭐NEJM 2021 phase III trial
✂️Resected ccRCC
Stage II AND g4 or sarcomatoid
OR
≥ stage III
OR
Reg LN mets
OR
Stage M1 & NED
💉1 yr adj pembro vs placebo
nejm.org/doi/full/10.10…
@TumorBoardTues @brian_rini 6/17 #TumorBoardTuesday
👨🏻🏫Mini tweetorial 3👨🏻🏫
✨KEYNOTE-564 (cont’d)
🥳Met primary outcome of improved (DFS)
📍 77.3% vs 68.1% at 24 mos (HR 0.68, 95% CI 0.53-0.87, p = 0.002)
🏛️FDA approved
☠️G3 or higher AE 32.4% pembro vs 17.7% placebo
💊7.4% high dose👺steroids (≥40mg/day)
👨🏻🏫Mini tweetorial 3👨🏻🏫
✨KEYNOTE-564 (cont’d)
🥳Met primary outcome of improved (DFS)
📍 77.3% vs 68.1% at 24 mos (HR 0.68, 95% CI 0.53-0.87, p = 0.002)
🏛️FDA approved
☠️G3 or higher AE 32.4% pembro vs 17.7% placebo
💊7.4% high dose👺steroids (≥40mg/day)
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 7/17 #TumorBoardTuesday
👨🏻🏫Mini tweetorial 4👨🏻🏫
✨KEYNOTE-564 (cont’d)
🕒Sept ‘22: F/u at median 30.1 mos
🥳DFS HR 0.63 (95% CI 0.50–0.80)
🤷OS data not mature
☠️No change in AE’s
📚thelancet.com/journals/lanon…
👀Is adj IO final word for high risk resected RCC?
👨🏻🏫Mini tweetorial 4👨🏻🏫
✨KEYNOTE-564 (cont’d)
🕒Sept ‘22: F/u at median 30.1 mos
🥳DFS HR 0.63 (95% CI 0.50–0.80)
🤷OS data not mature
☠️No change in AE’s
📚thelancet.com/journals/lanon…
👀Is adj IO final word for high risk resected RCC?
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 8/17 #TumorBoardTuesday
👨🏻🏫Mini tweetorial 5👨🏻🏫
🐎Hold your horses🐎
🚨At #ESMO22 we saw 3 RCC adjuvant IO trials rock the boat ⛵as all 3 failed to meet primary endpoint
✨CheckMate 914: Adju Nivo/Ipi vs Placebo
✨IMmotion010: Adj Atezo vs Placebo
✨PROSPER: Periop Nivo vs observe
👨🏻🏫Mini tweetorial 5👨🏻🏫
🐎Hold your horses🐎
🚨At #ESMO22 we saw 3 RCC adjuvant IO trials rock the boat ⛵as all 3 failed to meet primary endpoint
✨CheckMate 914: Adju Nivo/Ipi vs Placebo
✨IMmotion010: Adj Atezo vs Placebo
✨PROSPER: Periop Nivo vs observe
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 9/17 #TumorBoardTuesday #ESMO22
👨🏻🏫Mini tweetorial 6👨🏻🏫
📌RCC adj IO, 3 neg trials
✨CheckMate 914: Nivo/Ipi
❌DFS HR 0.92, p=0.53
✨IMmotion010: Atezo
❌DFS HR 0.93, p=0.50
✨PROSPER: Periop Nivo
❌RFS HR 0.97,p=0.43
🤿Diving further into these trials & compare to KEYNOTE-564!
👨🏻🏫Mini tweetorial 6👨🏻🏫
📌RCC adj IO, 3 neg trials
✨CheckMate 914: Nivo/Ipi
❌DFS HR 0.92, p=0.53
✨IMmotion010: Atezo
❌DFS HR 0.93, p=0.50
✨PROSPER: Periop Nivo
❌RFS HR 0.97,p=0.43
🤿Diving further into these trials & compare to KEYNOTE-564!
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 10/17 #TumorBoardTuesday #RenalCancer
👨🏻🏫Mini tweetorial 7👨🏻🏫
✨CheckMate 914
Nivolumab/Ipilimumab is anti-PD-1 + anti-CTLA-4
📆Given over 24 weeks vs 1 year pembro in KEYNOTE-564
☠️High toxicity ➡️ 32% discontinuation in treatment arm
📚thelancet.com/journals/lance…
👨🏻🏫Mini tweetorial 7👨🏻🏫
✨CheckMate 914
Nivolumab/Ipilimumab is anti-PD-1 + anti-CTLA-4
📆Given over 24 weeks vs 1 year pembro in KEYNOTE-564
☠️High toxicity ➡️ 32% discontinuation in treatment arm
📚thelancet.com/journals/lance…
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 11/17 #TumorBoardTuesday
👨🏻🏫Mini tweetorial 8👨🏻🏫
✨IMmotion010
Atezolizumab is anti-PD-L1 whereas Pembro is anti-PD-1
Does 🎯matter in adjuvant setting for #RCC?
➡️recall PD-1 expressed on native immune cells whereas PD-L1 overexpressed on tumor cells
📚thelancet.com/journals/lance…
👨🏻🏫Mini tweetorial 8👨🏻🏫
✨IMmotion010
Atezolizumab is anti-PD-L1 whereas Pembro is anti-PD-1
Does 🎯matter in adjuvant setting for #RCC?
➡️recall PD-1 expressed on native immune cells whereas PD-L1 overexpressed on tumor cells
📚thelancet.com/journals/lance…
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 12/17 #TumorBoardTuesday #ESMO22
👨🏻🏫Mini tweetorial 9👨🏻🏫
✨PROSPER
Nivolumab anti-PD-1 with at least one dose before surgery
➡️ 12% dropout rate in each arm
✂️ diff in waiting until surgical path/recovery? (✨KEYNOTE-564 started therapy within 12 wks)
📚oncologypro.esmo.org/meeting-resour…
👨🏻🏫Mini tweetorial 9👨🏻🏫
✨PROSPER
Nivolumab anti-PD-1 with at least one dose before surgery
➡️ 12% dropout rate in each arm
✂️ diff in waiting until surgical path/recovery? (✨KEYNOTE-564 started therapy within 12 wks)
📚oncologypro.esmo.org/meeting-resour…
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 13/17 #TumorBoardTuesday
🤜🏼How do we process this info?🤛🏼
🏛️Only pembro FDA approved with ➕ phase III data (DFS)
🕑OS data for adj trials will take more time
📌Take home
📋Consider adju pembro in CAREFULLY selected pts
👨🏻⚕️🤝👨🏾#SharedDecision: risks/benefits based on avail data
🤜🏼How do we process this info?🤛🏼
🏛️Only pembro FDA approved with ➕ phase III data (DFS)
🕑OS data for adj trials will take more time
📌Take home
📋Consider adju pembro in CAREFULLY selected pts
👨🏻⚕️🤝👨🏾#SharedDecision: risks/benefits based on avail data
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 14/17 #TumorBoardTuesday
Back to our case🔎
68yo 👨🏾
HTN
T2DM
Arthritis
✂️2022: L Radical Nephrectomy
🔬Clear cell #RenalCellCarcinoma
📏8.2 cm, G2, extends into renal vein (T3a)
❓No lymph nodes sampled (NX)
🦴No other dz sites
🤔Now knowing data, would you offer adjuvant IO?
Back to our case🔎
68yo 👨🏾
HTN
T2DM
Arthritis
✂️2022: L Radical Nephrectomy
🔬Clear cell #RenalCellCarcinoma
📏8.2 cm, G2, extends into renal vein (T3a)
❓No lymph nodes sampled (NX)
🦴No other dz sites
🤔Now knowing data, would you offer adjuvant IO?
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 15/17 #TumorBoardTuesday #RCC
✅ Meets criteria of KEYNOTE-564 (adjuvant pembro) with stage III disease
🤿 Dive into arthritis history prior to IO
🦴 Confirmed OA, & no PMH or FHx of autoimmune dx
🗨️ Let’s talk with the patient 👨🏾 about options! 🤝
✅ Meets criteria of KEYNOTE-564 (adjuvant pembro) with stage III disease
🤿 Dive into arthritis history prior to IO
🦴 Confirmed OA, & no PMH or FHx of autoimmune dx
🗨️ Let’s talk with the patient 👨🏾 about options! 🤝
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 16/17 #TumorBoardTuesday
👍Pros of adj pembro: improved DFS 🕺 in similar pts with high relapse risk
👎Cons: ≈ ⅓ pts with ≥ g3 tox, time 🕑+💰tox
🤔This patient started tx before CheckMate 914, IMmotion010, PROSPER results
❓How to discuss the results with similar patients❓
👍Pros of adj pembro: improved DFS 🕺 in similar pts with high relapse risk
👎Cons: ≈ ⅓ pts with ≥ g3 tox, time 🕑+💰tox
🤔This patient started tx before CheckMate 914, IMmotion010, PROSPER results
❓How to discuss the results with similar patients❓
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde 17/17 #TumorBoardTuesday
👨🏾Chose adjuvant pembro
1 treatment left 🥳
🙌Tolerating well, mild MSK pain
👺No steroids
🎉NED on scans!!!🎉
👨🏾Chose adjuvant pembro
1 treatment left 🥳
🙌Tolerating well, mild MSK pain
👺No steroids
🎉NED on scans!!!🎉
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde #PostTest Q1️⃣ #TumorBoardTuesday
👉🏽#CME Eval 🔗 integrityce.com/tbtEval
👉🏽ALL CME🔗 integrityce.com/tbt
🤔@brian_rini @JVentoMD taught us #RCC adj tx, test your🧠with quick Q’s
🧐Which IO is approved for adj tx of RCC at mod-high or high risk of recur post nephrectomy?
👉🏽#CME Eval 🔗 integrityce.com/tbtEval
👉🏽ALL CME🔗 integrityce.com/tbt
🤔@brian_rini @JVentoMD taught us #RCC adj tx, test your🧠with quick Q’s
🧐Which IO is approved for adj tx of RCC at mod-high or high risk of recur post nephrectomy?
@TumorBoardTues @brian_rini @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @QingZhangLab @DrRanaMcKay @DrScottHaake @MVossMD @archie_hh @DrTanWP @mtsiatas @sonpavde #PostTest Q2️⃣ #TumorBoardTuesday
👉🏽 Free CME (AMA & MOC)
🔗 integrityce.com/tbt
🧐 Which of the following is a post-operative prediction model which provides a review of expected oncological outcomes in patients with #RCC?
👉🏽 Free CME (AMA & MOC)
🔗 integrityce.com/tbt
🧐 Which of the following is a post-operative prediction model which provides a review of expected oncological outcomes in patients with #RCC?
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