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1 st Ibero-American Forum on Metastatic Renal Cell Carcinoma: Establishing A Continuum of Care to Improve Patient Outcomes Daniel Castellano Oncología.

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Presentation on theme: "1 st Ibero-American Forum on Metastatic Renal Cell Carcinoma: Establishing A Continuum of Care to Improve Patient Outcomes Daniel Castellano Oncología."— Presentation transcript:

1 1 st Ibero-American Forum on Metastatic Renal Cell Carcinoma: Establishing A Continuum of Care to Improve Patient Outcomes Daniel Castellano Oncología Médica.Unidad de Tumores GenitoUrinarios Hospital Universitario 12 de Octubre. I + 12 Research Institute. Chairman SOGUG March Buenos Aires,Argentina Spanish Oncology GenitoUrinary Group

2 1.US FDA. Sorafenib, US FDA. Sunitinib malate, US FDA. Temsirolimus, US FDA. Everolimus, US FDA. Bevacizumab, US FDA. Pazopanib, US FDA. Axitinib, 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 ??)

3 Algoritmo CCRm SettingPatientsTherapyOptions First-lineFavourable- or intermediate-risk Sunitinib Pazopanib Tivozanib ? Beva - IFN-α HD IL-2 Cytokines Sorafenib Poor-risk TemsirolimusSunitinib Second-linePrior 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 2013 SOGUG 2010 Third-linePrior TKI – TKI Everolimus Clinical Trial Prior TKI – mTOR Sorafenib/Dovitinib Clinical trial

4 New pathways and therapies in RCC More 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.

5 Dovitinib Anti-PD1 Sunitinib (Adjuvant Treatment) Future Treatment options for metastatic RCC …

6 Algoritmo CCRm – 2014? SettingPatientsTherapyOptions First-lineFavourable- or intermediate-risk Sunitinib Pazopanib Tivozanib ? Beva - IFN-α HD IL-2 Cytokines Sorafenib Poor-risk TemsirolimusSunitinib Second-linePrior 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 2013 SOGUG 2010 Third-linePrior TKI – TKI Everolimus Anti-PD1?? Clinical Trial Prior TKI – mTOR Sorafenib/Dovitinib Clinical trial

7 18 Possible areas of unmet medical need Currently approved treatments are not curative, and Patients develop progressive disease – Evolving need for effective therapeutics with unique mechanisms 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 !!!

8 Tipo Tratamiento: - Secuencial - Individualización Control Complicaciones Tumorales Tratamiento Integral Manejo Efectos Adversos Medicina Basada Evidencia (Est.Clínicos) Uso Racional de Recursos Beneficio Clínico Manejo Integral Multidisciplinar del Carcinoma Renal Avanzado

9 2 st Ibero-American Forum on Metastatic Renal Cell Carcinoma: Establishing A Continuum of Care to Improve Patient Outcomes March 2014 ?? Spanish Oncology GenitoUrinary Group

10 Muchas Gracias


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