Expert Practice On-Demand Presentations

Intermediate-risk renal cell carcinoma: Best choice and sequencing of therapy
Discussant: Camillo Porta, MD

A 58-year-old woman presents with metastatic disease 9 months following a radical nephrectomy for a T3aN0 clear cell carcinoma of the upper pole of the right kidney.

Karnofsky performance status: 90% (mild cough, no bone pain)
Labs: Hgb, calcium, LDH, and creatinine are normal
CXR/CT chest: Small bilateral pulmonary metastases (2 left, 4 right) ranging from 1-2 cm in diameter
Bone scan: Two small foci of increased uptake (rib and lumbar spine) suggestive of metastatic disease. Plain X-rays confirm mixed lytic/blastic metastases in both areas.

PART 1

Which of the following would you recommend for this patient with intermediate-risk metastatic renal cell carcinoma?(online surveys)

PART 2

Which best describes your approach to this patient’s asymptomatic bone metastases?(surveys)

PART 3

The patient experiences an objective partial response to initial therapy with sunitinib, but 8 months after beginning therapy she has symptomatic disease progression in lung and bone. Karnofsky performance status is now 80%.

PART 4

Everolimus (10 mg PD/d) is begun. After 6 weeks of therapy the patient complains of dyspnea on exertion and nonproductive cough. She is afebrile and CXR shows a small left pleural effusion.

Renal cell carcinoma: The emerging role of adjuvant and neoadjuvant therapy

Alastair W. S. Ritchie, MD
Medical Research Council
London, United Kingdom

Intermediate-risk renal cell carcinoma: Best choice and sequencing of therapy

Camillo Porta, MD
IRCCS San Matteo University Hospital
Pavia, Italy

PSA-only relapse following local therapy for high-risk prostate cancer

Kurt Miller, MD
Benjamin Franklin Medical Center
Berlin, Germany

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Peter Mulders, MD, PhD
University Medical Center Nijmegen
Nijmegen, The Netherlands

Castration-resistant prostate cancer: Optimal management of a patient with good performance status

Camillo Porta, MD
IRCCS San Matteo University Hospital
Pavia, Italy