Minimizing Toxicity While Maintaining Efficacy in RCC - Episode 10
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At times, a set of circumstances exists such that it may be appropriate for a patient with renal cell carcinoma (RCC) to stop therapy for a period of time. Nizar M. Tannir, MD, explains that patients with indolent disease who have achieved a good response and have survived 4 or 5 years are good candidates for taking a drug holiday. Daniel J. George, MD, notes that a drug holiday may also be appropriate in patients who have an oligometastatic or a single metastatic site that has been resected. Even if a patient has been treated with a systemic therapy previously, resuming therapy can often be delayed. Regular scanning (every 3 months) would be done to check for disease progression.
Sumanta Kumar Pal, MD, mentions the phase III ECOG 2810 trial comparing pazopanib versus placebo in patients with metastatic RCC who had no evidence of disease following metastatectomy. Pal says the study acknowledges the fact that there is a very high risk of recurrence in this population.
Brian Rini, MD, says that the appropriate duration for a drug holiday varies. Some of his patients have been observed for more than 3 years. In other cases, a 10-week break may be more appropriate. The length of time is dependent on the disease progression. Pal notes that the longest holiday he has offered is closer to 4 to 6 months. Some of George’s patients have had a good enough response to take a 3-year drug holiday. With other patients, more dramatic progression occurs after a relatively short period of time following therapy cessation. Moderator Robert Figlin, MD, comments that, there are still a lot of uncertainties regarding the reasons why some patients experience prolonged remissions. Rini adds that, in his experience with axitinib, patients benefit greatly from frequent, short drug holidays of just 2 or 3 days. This break seems to reset the toxicities, and the positive effects of this break can last for several weeks.