Chung-Han Lee, MD, PhD

Case Presentation: A 69-Year-Old Woman with Advanced RCC

Advanced RCC: Prognosis and Therapy Selection

Initial Management of Advanced RCC

Second-Line Therapy Decision Factors

Second-Line Treatment: TKI Combination Therapy

A 69-year-old woman presents with a 2-month history of fatigue, lower back pain and unintentional weight loss

PE: flank and lower back discomfort on palpation

Chest/abdominal/pelvic CT showed a right-sided 7.9 cm renal mass; paraaortic lymph node involvement

Percutaneous biopsy confirmed clear cell renal cell carcinoma

The patient underwent right total nephrectomy; surgery was well-tolerated

Follow-up at 3, 9, 12 months were unremarkable

At 24 months the patient developed disease with multifocal disease in her lungs; Stage IV

ECOG 0; good risk disease by IMDC and MSKCC risk

She started treatment on pazopanib; well-tolerated, achieved PR

2 year later the patient suffered progression of disease; with increasing lung nodules, largest (30 mm)

Lenvatinib 18 mg PO QD + everolimus 5 mg PO QD was initiated

Imaging at week 8 showed a 33% reduction from baseline of the largest lung lesion (20 mm);

At week 24 of treatment showed 40% reduction from baseline of largest lung lesion (18 mm); decrease in size of other pulmonary lesions noted

At 6 months she continued to have stable disease

At 12 months of treatment CT showed 2 new liver nodules

Videos

An expert oncologist presents the case of a 69-year-old woman with advanced renal cell carcinoma, and considers available treatment options for patients with a similar disease setting.

A 69-Year-Old Woman With Advanced Renal Cell Carcinoma

Chung-Han Lee, MD, PhD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses the efficacy of a phase 2 study (NCT02501096) of pembrolizumab (Keytruda) and lenvatinib (Lenvima) in patient with metastatic clear cell renal cell carcinoma (ccRCC) who have progressed on an immune checkpoint inhibitor.

Lee says that in this setting, the trial was able to demonstrate a high objective response rate of 55% in patients by immune-related Response Evaluation Criteria in Solid Tumors (RECIST) and 52% by RECIST version 1.1. For the patients who responded, the median duration of response was about 10 months, and most patients with metastatic ccRCC remained on treatment at the time of the data cutoff, which was April 9, 2020. Forty-six of the 91 patients with confirmed partial responses.

For the entire group of patients on this trial, there was a median progression-free survival of 11.7 months, and 45% of the total population remained progression-free at the 12-month time point, according to Lee. No new safety signals were observed in this trial, and the most common treatment-related adverse events were fatigue, diarrhea, and proteinuria.

<< View more resources and information regarding renal cell carcinoma

Chung-Han Lee, MD, PhD, discusses the efficacy of a phase 2 study of pembrolizumab and lenvatinib in patient with metastatic clear cell renal cell carcinoma who have progressed on an immune checkpoint inhibitor.

Phase 2 Trial Shows Antitumor Activity in Metastatic Clear Cell RCC

Chung-Han Lee, MD, PhD, medical oncologist, Memorial Sloan Kettering Cancer Center (MSK), discusses the rationale for the phase II study of lenvatinib (Lenvima) plus pembrolizumab (Keytruda) for disease progression after PD-1/PD-L1 immune checkpoint inhibitor in metastatic clear cell renal cell carcinoma (ccRCC).

Combinations of anti-VEGF and PD-1/PD-L1 inhibitors have shown great efficacy in clinical studies involving patients with kidney cancer. The question then became whether these combinations would still be effective in patients who previously progressed on a PD-1 inhibitor. Because of the speculation surrounding the idea of treating patients with another immune checkpoint inhibitor after they progressed on one, researchers at MSK decided to launch a study.

The results of the interim analysis, which included 33 patients from the study, showed partial responses in 64% of patients at 24 weeks of follow-up. The study also demonstrated a median progression-free survival of 11.2 months.

Chung-Han Lee, MD, PhD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses the rationale for the phase II study of lenvatinib plus pembrolizumab for disease progression after PD-1/PD-L1 immune checkpoint inhibitor in metastatic clear cell renal cell carcinoma.<br />
&nbsp;

Chung-Han Lee, MD, PhD | Authors

Articles

A 69-Year-Old Woman With Advanced Renal Cell Carcinoma

Phase 2 Trial Shows Antitumor Activity in Metastatic Clear Cell RCC

Discussing the Phase II Study of Lenvatinib/Pembrolizumab in Metastatic ccRCC