clinical cases

[GUoncologist]

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ctDNA 2-4w after surgery. If positive, CapeOx x4. If negative, monitor.

May I ask why not cape monotherapy for 6 months?

 

[gutonc]

May I ask why not cape monotherapy for 6 months?

Mostly extrapolating from the IDEA collaborative data. If someone can't tolerate oxali, I'll just do cape.

 

[Royster33]

ctDNA 2-4w after surgery. If positive, CapeOx x4. If negative, monitor.

Did you mean 3 months? I am not familiar with x 4. Either way I think this is a good middle ground in these borderline cases.

 

[gutonc]

Did you mean 3 months? I am not familiar with x 4. Either way I think this is a good middle ground in these borderline cases.

4 cycles = 3 months

 

[ONC2023]

42 year old.

Bilateral renal masses, biopsy proven ccRCC (called low grade on path).

The left mass is so large it needs radical nephrectomy. The right mass is borderline.

She’s seeing me for neoadjuvant treatment to shrink them before urology goes in.

I like the idea of dual IO in young people because it’s the best chance of a durable response, but the response rate is lower than IO/TKI.

Would anyone do “neoadjuvant” dual IO, or do you prioritize the ORR of TKI’s in this setting? I’m leaning toward IO/TKI - either Cabo/nivo or if the patient is ok with the toxicity, Len/pembro.

 

[HemeOncHopeful19]

42 year old.

Bilateral renal masses, biopsy proven ccRCC (called low grade on path).

The left mass is so large it needs radical nephrectomy. The right mass is borderline.

She’s seeing me for neoadjuvant treatment to shrink them before urology goes in.

I like the idea of dual IO in young people because it’s the best chance of a durable response, but the response rate is lower than IO/TKI.

Would anyone do “neoadjuvant” dual IO, or do you prioritize the ORR of TKI’s in this setting? I’m leaning toward IO/TKI - either Cabo/nivo or if the patient is ok with the toxicity, Len/pembro.

I would probably do what you’re doing. We love the idea of those sustained CRs with dual IO but in reality it’s like… 10-15%?

If it is the chance or staying off dialysis I’d probably lean toward IO/TKI. Response rates are higher and you’re still getting exposure to IO anyway.

 

[GUoncologist]

I would probably do what you’re doing. We love the idea of those sustained CRs with dual IO but in reality it’s like… 10-15%?

If it is the chance or staying off dialysis I’d probably lean toward IO/TKI. Response rates are higher and you’re still getting exposure to IO anyway.

I agree, while in the metastatic setting there is a good argument for io/io, I would do pembro lenva for cytoreduction prior to surgery, especially if there is no sarcomatoid differentiation.

I'm sure you are planning this, but would make sure he has genetic testing. Likelihood >10% you'll find something.