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Spanish Oncology GenitoUrinary Group. 1 st Ibero-American Forum on Metastatic Renal Cell Carcinoma: Establishing A Continuum of Care to Improve Patient Outcomes. 14-15 March 2013 . Buenos Aires,Argentina. Daniel Castellano Oncología Médica.Unidad de Tumores GenitoUrinarios - PowerPoint PPT Presentation
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1st Ibero-American Forum on Metastatic Renal Cell
Carcinoma: Establishing A Continuum of Care to
Improve Patient Outcomes
Daniel CastellanoOncología Médica.Unidad de Tumores
GenitoUrinariosHospital Universitario 12 de Octubre.
I + 12 Research Institute. Chairman SOGUG
14-15 March 2013. Buenos Aires,Argentina
Spanish Oncology GenitoUrinary Group
1. US FDA. Sorafenib, 2005.2. US FDA. Sunitinib malate, 2006.3. US FDA. Temsirolimus, 2007.4. US FDA. Everolimus, 2009.5. US FDA. Bevacizumab, 2009.6. US FDA. Pazopanib, 2009.7. US FDA. Axitinib, 2012.
1992-2005 2005 2006 2007 2008 2009 2010 2011 2012 1992-2005 2005 2006 2007 2008 2009 2010 2011 2012
IFN-α
High dose interleukin-2
Sunitinib (Jan 2006)2
Sorafenib (Dec 2005)1
Temsirolimus (May 2007)3
Pazopanib (Oct 2009)6
Bevacizumab + IFN-α(Jul 2009)5
Everolimus (Mar 2009)4
Axitinib (Jan 2012)7
Treatment options for metastatic RCC have been revolutionised in a short period of time…
Tivozanib (2013 ??)
Algoritmo CCRm - 2013Setting Patients Therapy Options
First-line Favourable- or
intermediate-riskSunitinib
Pazopanib
Tivozanib ?
Beva - IFN-α
HD IL-2
CytokinesSorafenib
Poor-risk Temsirolimus Sunitinib
Second-line Prior cytokine Axitinib
Pazopanib
Sorafenib
Sunitinib
Prior VEGF–TKI Axitinib Sorafenib ?
Prior VEGF–TKI Everolimus Clinical trial
Adapted from EAU guidelines 2010, ESMO Clinical Recommendations 2012,
NCCN guidelines 2013SOGUG 2010
Third-line Prior TKI – TKI Everolimus Clinical Trial
Prior TKI – mTOR Sorafenib/Dovitinib Clinical trial
New pathways and therapies in RCCMore potent VEGFR2 TKIs
Axitinib (confirmed) Tivozanib (confirmed)
Novel antiangiogenics Angiopoietin inhibitor (not confirmed) VEGFR2 antibody (pending) DLL4 inhibitor (pending) FGF Inhibitors (pending) PI3K/Akt/mTOR inhibitors (early)
Novel immunotherapy Ipilimumab (stopped)Anti-PD-1 (pending)Anti-PDL-1 (stopped)
RCC = renal cell carcinoma; VEGFR = vascular endothelial growth factor receptor; TKIs = tyrosine kinase inhibitors; DLL4 = delta-like-4. Pal et al, 2010; Loges et al, 2010; Duignan et al, 2011.
2013 2014 2015 2013 2014 2015
Dovitinib
Anti-PD1
Sunitinib (Adjuvant
Treatment)
Future Treatment options for metastatic RCC …
Algoritmo CCRm – 2014?Setting Patients Therapy Options
First-line Favourable- or
intermediate-riskSunitinib
Pazopanib
Tivozanib ?
Beva - IFN-α
HD IL-2
CytokinesSorafenib
Poor-risk Temsirolimus Sunitinib
Second-line Prior cytokine Axitinib
Pazopanib
Sorafenib
Sunitinib
Prior VEGF–TKI Axitinib Sorafenib ?
Prior VEGF–TKI Everolimus Clinical trial
Adapted from EAU guidelines 2010, ESMO Clinical Recommendations 2012,
NCCN guidelines 2013SOGUG 2010
Third-line Prior TKI – TKI Everolimus
Anti-PD1??
Clinical Trial
Prior TKI – mTOR Sorafenib/Dovitinib Clinical trial
18
Possible areas of unmet medical need
Currently approved treatments are not curative, and Patients develop progressive disease
– Evolving need for effective therapeutics with uniquemechanisms of action for patients who progress
Non–clear cell histologies– Few studies are available to determine efficacy
Biomarkers, new pathways, gene profile,
mechanisms of resistance !!!
Tipo Tipo Tratamiento:Tratamiento:
- Secuencial Secuencial - IndividualizaciIndividualizaci
ónón
Control Control ComplicacioneComplicaciones Tumoraless Tumorales
Tratamiento
IntegralManejo Manejo Efectos Efectos
AdversosAdversos
Medicina Basada
Evidencia(Est.Clínicos)
Uso Racional de Recursos
Beneficio Clínico
Manejo Integral Multidisciplinar del Carcinoma
Renal Avanzado
2st Ibero-American Forum on Metastatic Renal Cell Carcinoma:
Establishing A Continuum of Care to
Improve Patient Outcomes
March 2014 ??
Spanish Oncology GenitoUrinary Group
Muchas Gracias