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Daniel Castellano Oncología Médica.Unidad de Tumores GenitoUrinarios

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

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Daniel Castellano Oncología Médica.Unidad de Tumores GenitoUrinarios

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  1. Spanish Oncology GenitoUrinary Group 1st 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 Hospital Universitario 12 de Octubre. I + 12 Research Institute. Chairman SOGUG

  2. Treatment options for metastatic RCC have been revolutionised in a short period of time… Pazopanib (Oct 2009)6 Sunitinib (Jan 2006)2 Sorafenib (Dec 2005)1 Bevacizumab + IFN-α(Jul 2009)5 Axitinib (Jan 2012)7 High dose interleukin-2 Temsirolimus (May 2007)3 IFN-α Everolimus (Mar 2009)4 1992-2005 2005 2006 2007 2008 2009 2010 2011 2012 US FDA. Sorafenib, 2005. US FDA. Sunitinib malate, 2006. US FDA. Temsirolimus, 2007. US FDA. Everolimus, 2009. US FDA. Bevacizumab, 2009. US FDA. Pazopanib, 2009. US FDA. Axitinib, 2012. Tivozanib (2013 ??)

  3. Algoritmo CCRm - 2013 Adapted from EAU guidelines 2010, ESMO Clinical Recommendations 2012, NCCN guidelines 2013 SOGUG 2010

  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. Future Treatment options for metastatic RCC … Anti-PD1 Sunitinib (Adjuvant Treatment) Dovitinib 2013 2014 2015

  6. Algoritmo CCRm – 2014? Adapted from EAU guidelines 2010, ESMO Clinical Recommendations 2012, NCCN guidelines 2013 SOGUG 2010

  7. Possibleareasofunmetmedicalneed Currentlyapprovedtreatmentsarenotcurative,and Patients developprogressivedisease –Evolvingneedforeffectivetherapeuticswithunique mechanismsofactionforpatientswhoprogress Non–clearcellhistologies –Fewstudiesareavailabletodetermineefficacy Biomarkers, new pathways, gene profile, mechanisms of resistance !!! 18

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

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

  10. Muchas Gracias

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