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Moderator Robert A. Figlin, MD, introduces a panel discussion focused on minimizing toxicity while maintaining efficacy in the treatment of patients with renal cell carcinoma. The conversation features expert analysis from Daniel J. George, MD, Sumanta Kumar Pal, MD, Brian I. Rini, MD, and Nizar M. Tannir, MD.
Most patients with untreated metastatic renal cell carcinoma (mRCC) have already undergone nephrectomy, Rini notes. At this point, the standard frontline treatment is usually the VEGF inhibitor sunitinib, since it is supported by the strongest clinical data. However, the management of side effects with any frontline therapy relies heavily on a treatment team that includes oncology nurses, Rini adds.
Some patients with untreated mRCC have not yet undergone nephrectomy, notes George. In these situations, it helps to work in a multidisciplinary environment that includes surgeons, in order to accelerate the treatment process.
Following the initiation frontline therapy, Pal recommends that a patient should be reevaluated after 2 weeks, since the first few weeks following the administration of treatment is important for assessing the occurrence of adverse events. After this time, patients may safely switch to a monthly visit. Alternate treatment schedules have been explored in clinical trials, as a means of reducing side effects. However, Rini recommends starting sunitinib at the standard 50-mg daily dose for 4 weeks, followed by 2 weeks off.