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Accreditation/ Credit Designation

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. These activites are not approved for AMA PRA Category 1 Credit

Acknowledgement of Commercial Support

This activity is supported by educational grants from Exelixis, Inc. and Prometheus Laboratories Inc.


Community Practice Connections™: The Next Generation in Renal Cell Carcinoma Treatment: An Oncology Nursing Essentials Workshop PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap


1 of 3
PER Pulse™ Recap

First-Line Therapy for Patients With Metastatic Renal Cell Carcinoma

The live continuing education activity The Next Generation in Renal Cell Carcinoma Treatment: An Oncology Nursing Essentials Workshop featured key oncology nurses and physicians Laura S. Wood, RN, MSN, OCN; Nancy P. Moldawer RN, MSN; Virginia J. Seery, MSN, RN, ANP-BC; and Robert Figlin, MD, discussing the changing therapeutic landscape for patients with renal cell carcinoma (RCC). This program featured an overview of current treatment approaches, including targeted therapies and immunotherapy, as well as key considerations for managing the adverse events associated with therapy. This first of 3 PER PulseTM Recaps reviews treatment options for patients with newly diagnosed, metastatic RCC.

  • The discovery that RCC is associated with inappropriate signaling through the vascular endothelial growth factor (VEGF) pathway and the mechanistic target of rapamycin (mTOR) pathway led to the development of targeted agents to inhibit these molecules.
  • Category 1 recommendations in national guidelines for newly diagnosed patients include inhibitors of the VEGF receptor (pazopanib, sunitinib), antibodies to VEGF (bevacizumab plus interferon), and inhibitors of mTOR (temsirolimus for poor-prognosis patients).
  • Cabozantinib, which is currently approved for previously treated patients, has been directly compared with sunitinib as first-line therapy in the phase 2 CABOSUN trial. The primary endpoint of progression-free survival was superior in the cabozantinib arm, leading to filing of a supplemental New Drug Application with the US Food and Drug Administration.

For additional commentary about this topic and the The Next Generation in Renal Cell Carcinoma Treatment: An Oncology Nursing Essentials Workshop symposium, please visit www.gotoper.com.


2 of 3
PER Pulse™ Recap

Management of Patients With Previously-Treated, Metastatic Renal Cell Carcinoma

The live continuing education activity The Next Generation in Renal Cell Carcinoma Treatment: An Oncology Nursing Essentials Workshop featured key oncology nurses and physicians Laura S. Wood, RN, MSN, OCN; Nancy P. Moldawer RN, MSN; Virginia J. Seery, MSN, RN, ANP-BC; and Robert Figlin, MD, discussing the changing therapeutic landscape for patients with renal cell carcinoma (RCC). This program featured an overview of current treatment approaches, including targeted therapies and immunotherapy, as well as key considerations for managing the adverse events associated with therapy. This second of 3 PER PulseTM Recaps reviews subsequent lines of therapy for patients with metastatic RCC.

  • In the post–targeted therapy setting, the mechanistic target of rapamycin inhibitor everolimus became a standard of care based on the RECORD-1 trial, and subsequently became the reference regimen for the development of next-generation therapies.
  • The immune checkpoint inhibitor nivolumab received regulatory approval based on superior overall survival (OS) compared with everolimus in the phase III CheckMate 025 trial, although there was no significant difference in progression-free survival (PFS).
  • Subsequently, the phase III METEOR trial demonstrated superior PFS and OS with cabozantinib compared with everolimus, leading to approval.
  • The combination of lenvatinib and everolimus was also approved for previously treated patients based on a phase II trial comparing the combination to single-agent everolimus.

For additional commentary about this topic and the The Next Generation in Renal Cell Carcinoma Treatment: An Oncology Nursing Essentials Workshop symposium, please visit www.gotoper.com.


3 of 3
PER Pulse™ Recap

Managing Adverse Events in Patients With Renal Cell Carcinoma

The live continuing education activity The Next Generation in Renal Cell Carcinoma Treatment: An Oncology Nursing Essentials Workshop featured key oncology nurses and physicians Laura S. Wood, RN, MSN, OCN; Nancy P. Moldawer RN, MSN; Virginia J. Seery, MSN, RN, ANP-BC; and Robert Figlin, MD, discussing the changing therapeutic landscape for patients with renal cell carcinoma (RCC). This program featured an overview of current treatment approaches, including targeted therapies and immunotherapy, as well as key considerations for managing the adverse events associated with therapy. This third of 3 PER PulseTM Recaps summarizes commentary from the experts in this activity for mitigating and managing adverse events in patients with metastatic RCC.

  • Although inhibitors of the vascular endothelial growth factor receptor (VEGFR) and the mechanistic target of rapamycin (mTOR) are targeted agents, they have distinct toxicity profiles. Adverse events associated with mTOR inhibitors include pneumonitis, hyperglycemia, and hypercholesterolemia, while VEGFR inhibitors are associated with hand-foot syndrome, diarrhea, and hypertension.
    • For mTOR inhibitors, patients should be monitored for shortness of breath and cough.
    • li<>In terms of VEGFR inhibitor–associated hypertension, daily blood pressure monitoring is recommended, along with providing the patient with specific systolic and diastolic readings that would prompt alerting the health care team.
  • Diarrhea is a toxicity that occurs with targeted agents as well as immunotherapy. However, the mechanism is different; while steroids are rarely required for diarrhea associated with targeted agents, steroids are routinely used for immunotherapy-associated diarrhea. Given that both targeted agents and immunotherapy are used in the continuum of care for patients with metastatic RCC, it is important to educate the patient in this area.
  • For immune-related adverse events (irAEs), a given symptom may not seem severe, but might be the sign of a life-threating side effect. Therefore, it is important to recognize and quickly report irAEs. Furthermore, it is ideal to call during a time of day that would allow clinical staff familiar with the patient to address the symptoms.

For additional commentary about this topic and the The Next Generation in Renal Cell Carcinoma Treatment: An Oncology Nursing Essentials Workshop symposium, please visit www.gotoper.com.





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