Dr Vaishampayan on Toxicities Associated With Various Treatments in RCC

Ulka Nitin Vaishampayan, MBBS, director, the Phase I Program at Rogel Cancer Center, professor of internal medicine, University of Michigan, discusses toxicities associated with various treatment options for patients with renal cell carcinoma (RCC).

Regarding TKIs, common adverse effects (AEs) typically include high blood pressure, diarrhea, and skin rash, Vaishampayan begins. Although these toxicities are common among anticancer therapies, they should be anticipated when anticipated when administering a TKI, and clinicians should have a strategy in place in preparation to manage these AEs, Vaishampayan says. She stresses the importance of informing the patient and their caregivers of monitoring for these toxicities. 

If these toxicities do occur, they need to be managed rapidly, Vaishampayan expands. Quick intervention allows for a greater likelihood for patients to remain on their respective therapies long term and potentially continue to derive benefit, she says.

However, patients who are frail could be more likely to experience significant toxicities, Vaishampayan says. When making treatment decisions for patients who are frail or have comorbidities, picking an agent such as axitinib (Inlyta) could allow for faster management and reversal of toxicities associated with this treatment, she explains. Agents such as lenvatinib (Lenvima) and cabozantinib (Cabometyx) have a longer half-life, which is something to consider when selecting treatment for this patient population, she adds.

Notably, dose adjustments of many treatments for RCC could help with the management of AEs, she explains, noting this is an option when toxicities begin to affect quality of life for patients or AEs recur.

One example of early toxicity management was seen with the regimen used in the phase 3 CheckMate 9ER (NCT03141177), which evaluated cabozantinib plus nivolumab (Opdivo), she says. The cabozantinib starting dose was reduced to 40 mg to help alleviate some of the toxicity that could be seen with this medication, Vaishampayan concludes.