Minimizing Toxicity While Maintaining Efficacy in RCC - Episode 14

RCC Journal Highlights and Implications for Clinical Practice

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Robert Figlin, MD, begins by discussing a recent article by Shuch et al,1 which describes patient characteristics that warrant referral of a patient with renal cell carcinoma (RCC) to a genetic counselor. Daniel J. George, MD, notes that for kidney cancer, the median age at diagnosis is about 65 years; he refers patients who are diagnosed in their mid-40s to a hereditary cancer clinic, as the incidence of hereditary cancers is higher in younger patients.

Next, Figlin mentions an article by Thomas-Schoemann et al2 that describes drug interactions associated with targeted therapies. Figlin comments that many patients who come to the clinic for chemotherapy are taking other drugs, for example, for hypertension, diabetes, or inflammatory diseases. Brian Rini, MD, notes that the electronic medical record used in his practice provides alerts regarding drug interactions. Rini also consults with pharmacists as needed, and adds that for patients involved in clinical trials, there may be additional requirements in terms of prohibited drugs.

Figlin then describes the results of study by Keizman et al,3 which show that smoking is associated with poorer outcomes (reduced progression-free survival and overall survival) in patients receiving a tyrosine kinase inhibitor for metastatic RCC. The metabolism of drugs for RCC is affected by other substances that a patient takes, notes Figlin. Nizar M. Tannir, MD, adds that it is important to ask patients about over-the-counter drugs and nutraceuticals that they may be taking in addition to prescription medications.

Potential drug-drug interactions should be taken into account when considering a new therapy for kidney cancer, as these interactions may potentially result in more toxicity or make therapy less effective, comments Figlin.


  1. Shuch B, Vourganti S, Ricketts CJ, et al. Defining early-onset kidney cancer: implications for germline and somatic mutation testing and clinical management. J Clin Oncol. 2014;32(5):431-437.
  2. Thomas-Schoemann A, Blanchet B, Bardin C, et al. Drug interactions with solid tumour-targeted therapies. Crit Rev Oncol Hematol. 2014;89(1):179-196.
  3. Keizman D, Gottfried M, Ish-Shalom M, et al. Active smoking may negatively affect response rate, progression-free survival, and overall survival of patients with metastatic renal cell carcinoma treated with sunitinib. Oncologist. 2014;19(1):51-60.