Risk Stratification of Patients with Advanced Renal Cell Carcinoma


Nizar Tannir, MD, provides an overview of the method of risk stratification for advanced RCC and the NCCN Guidelines for treatment based on risk group.

Nizar Tannir, MD: Hello, and welcome to our Targeted Oncology Virtual Tumor Board, which is focused on advances in frontline therapy of advanced clear cell renal cell carcinoma. I’m Nizar Tannir. I’m a professor in the department of genitourinary medical oncology at The University of Texas MD Anderson Cancer Center. I’m joined by my esteemed colleagues Dr Scott Tykodi, an associate professor of oncology at the University of Washington and Fred Hutchinson Cancer Center; and Dr Moshe Ornstein, a genitourinary medical oncologist at the Cleveland Clinic Taussig Cancer Institute.

In this presentation, my colleagues and I will review clinical cases, discuss approaches to treating patients with advanced renal cell carcinoma, and share our perspectives on key clinical trial data that may impact our treatment decisions. Let’s get started.

You’re all familiar with the IMDC [International Metastatic Renal Cell Carcinoma Database Consortium] risk categorization. There are 4 laboratory factors and 2 clinical factors that independently influence survival of patients with advanced renal cell carcinoma. There are 6 risk factors. The 2 clinical risk factors are: less than 1 year from time of diagnosis to systemic therapy, and a Karnofsky Performance Score of less than 80%. The 4 laboratory factors are anemia, neutrophilia, elevated corrected serum calcium level, and thrombocytosis. Fit patients with favorable risk won’t have any of these risk factors. Patients with intermediate risk will have 1 or 2 of these risk factors.

Patients with poor risk will have 3 or more. The median survival for patients with favorable risk, intermediate risk, and poor risk is 43.2 months, 22.5 months, and 7.8 months, respectively. I’d like to note that these survival data are from the era of targeted therapies. This is now in flux. It’s changing, as we now have immune checkpoint therapy in the first-line therapy of these patients.

These are the NCCN [National Comprehensive Cancer Network] Guidelines. You’re all familiar with NCCN Guidelines. We refer to them. This is a summary of therapies in the first-line setting for advanced clear cell renal cell carcinoma. I’d like to point out that our focus on this program is on the most common type of renal cell carcinoma: clear cell or conventional type renal cell carcinoma.

I’d like to draw our attention to the first column, which is the preferred regimens for favorable risk as we have defined them by IMDC. The 3 regimens that have received category 1 by the NCCN are axitinib plus pembrolizumab, cabozantinib plus nivolumab, and lenvatinib plus pembrolizumab. For patients with poor and intermediate risk, the 5 therapies that have been selected as preferred regimens for patients with advanced renal cell carcinoma are axitinib plus pembrolizumab, cabozantinib plus nivolumab, ipilimumab plus nivolumab, lenvatinib plus pembrolizumab, and cabozantinib. Note that 4 of these have received category 1 based on high-level evidence based on randomized phase 3 trials. Cabozantinib was based on a randomized phase 2 trial, CABOSUN.

Transcript edited for clarity.

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