Robert Figlin, MD, FACP, professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, director, Division of Hematology Oncology, deputy director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, provides advice to community oncologists who are treating patients with renal cell carcinoma (RCC).

Figlin explains that, for practitioners, the RCC field can be complicated. First, oncologists need to navigate through the various therapeutic options and choose which therapy is best for individual patients. Additional challenges include proper management of toxicities associated with some of the newer therapies and treatment of patients with comorbidities.

It is also important to understand optimal dosing and scheduling of treatment, he adds. Practitioners should also have a treatment plan for patients, so that there is an understanding of which therapies should be administered in various settings.

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Robert Figlin, MD, FACP, professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, director, Division of Hematology Oncology, deputy director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, provides advice to community oncologists who are treating patients with renal cell carcinoma.

Dr. Figlin on Advice for Oncologists Treating RCC

Robert Figlin, MD, FACP, professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, director, Division of Hematology Oncology, deputy director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, discusses newer methods of administering sunitinib (Sutent) to patients with renal cell carcinoma (RCC).

Several discoveries have been made in RCC, Figlin explains, with regard to existing TKIs and emerging agents that are changing the treatment paradigm. For example, there have been new methods for administering sunitinib, which has been approved for patients since 2006. Sunitinib was previously administered on a regimen consisting of 4 weeks of treatment and 2 weeks of rest.

Now, giving patients the same dosage to patients on a schedule of 2 weeks of treatment and 1 week of rest is equally effective, decreases toxicities, and allows patients to have better quality of life, Figlin says.

Robert Figlin, MD, FACP, professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, director, Division of Hematology Oncology, deputy director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, discusses newer methods of administering sunitinib (Sutent) to patients with renal cell carcinoma.

Dr. Figlin on Sunitinib for Patients With RCC

Robert Figlin, MD, FACP, professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, director, Division of Hematology Oncology, deputy director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai, discusses the ongoing phase III ADAPT trial, which examines AGS-003 combined with sunitinib for the treatment of patients with metastatic renal cell carcinoma (mRCC).

Patients enrolled in the study present with clear cell mRCC, Figlin explains, and are treated with surgical resection before their tissues are harvested. Patients are then randomized to receive sunitinib combined with AGS-003, an autologous immunotherapy designed to induce a T-cell response specific to tumor antigens, or sunitinib alone, which is the standard of care. The study is expected to complete randomization over the next several months, he says.

This is the largest study that has been conducted within this population and has enrolled more than 1000 patients, Figlin says. It is also unique in that it examines AGS-003, a personalized immunotherapy, which extracts a tumor’s RNA, places it onto the dendritic cells, and stimulates the immune system, in combination with sunitinib, which is said to reverse immune suppression and control disease.

Robert Figlin, MD, FACP, professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, director, Division of Hematology Oncology, deputy director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai, discusses the ongoing phase III ADAPT trial, which examines AGS-003 combined with sunitinib for the treatment of patients with mRCC.

Dr. Figlin on Ongoing ADAPT Trial for mRCC

Robert Figlin, MD, FACP, Professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, Cedars-Sinai Medical Center, discusses recent advances in the field of immunotherapy for kidney cancer.

The role of immunotherapy in kidney cancer is as exciting as it has ever been, Figlin says. Following the approval of interleukin-2 (IL-2), many patients have been free of their cancer for decades, though challenges existed regarding toxicity and frequency of benefit.

Figlin says oncologists and researchers should be excited about the reintroduction of immunotherapies into the kidney cancer treatment paradigm in the form of checkpoint inhibitors ipilimumab and nivolumab.

Dr. Figlin on Advances in Immunotherapy for Kidney Cancer

Robert Figlin, MD, FACP, Professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, Cedars-Sinai Medical Center, discusses an analysis of the heterogeneity of intermediate prognosis patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib.

The Memorial Sloan Kettering Cancer Center risk model uses 5 risk factors to divide patients with mRCC into 3 prognostic groups. Researchers associated with this analysis identified 548 intermediate prognosis mRCC patients treated with sunitinib in 6 prospective phase II and III clinical trials.

Figlin says that performance status and time from diagnosis stratify intermediate prognosis patients into better and poorer groups: Progression-free survival and overall survival were superior in patients with 1 versus 2 risk factors and ECOG performance status demonstrated to be an important factor.

Robert Figlin, MD, FACP, discusses an analysis of the heterogeneity of intermediate prognosis patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib.

Dr. Figlin on Intermediate Prognosis Patients With mRCC

Robert Figlin, MD, FACP, Professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, Cedars-Sinai Medical Center, discusses results from a single-arm phase II trial of the autologous dendritic cell immunotherapy AGS-003 plus standard treatment for patients with newly diagnosed metastatic renal cell carcinoma (mRCC).

In the trial, patients with mRCC received AGS-003 combined with sunitinib, Figlin says. The updated results show impressive survival findings, including a doubling in progression-free survival and an improvement in overall survival, for patients in the trial compared with a cohort of similar patients that were matched from other trials.

These impressive results set the stage for the ongoing randomized phase III ADAPT trial. Given the promising results from the phase II trial, Figlin is optimistic that AGS-003 should be able to demonstrate that a personalized vaccine in combination with sunitinib can enhance outcomes for patients with newly diagnosed mRCC, Figlin believes.

View more from the 2014 GU Cancers Symposium

Robert Figlin, MD, FACP, discusses updated data on the ADAPT trial, which is an ongoing international phase III randomized trial of autologous dendritic cell immunotherapy (AGS-003) plus standard treatment in metastatic renal cell carcinoma (mRCC)

Dr. Figlin Describes the Efficacy of AGS-003 in mRCC

Robert Figlin, MD, FACP, Professor of Medicine and Biomedical Sciences, Steven Spielberg Family Chair in Hematology Oncology, Cedars-Sinai Medical Center, discusses the sequencing of mTOR inhibitors and tyrosine kinase inhibitors (TKI) in renal cell carcinoma.

Figlin points out that in previously-untreated patients a vascular endothelial growth factor receptor (VEGFR) TKI is the treatment of choice for many physicians. There is a small number of patients that receive high-dose IL-2 or temsirolimus based on prognosis.

When determining the appropriate sequencing of agents and the opportunity arises to treat with an mTOR inhibitor (such as everolimus) or another TKI (such as axitinib), Figlin says, it is important for a physician to consider a patient's sensitivity to a pathway inhibitor.

In his practice, Figlin says he keeps a patient on a VEGF TKI in the second-line setting if their initial response to a TKI is outstanding. If the response has been modest and there is an appearance of new disease or rapid progression, Figlin considers the use of an mTOR inhibitor. Figlin's strategy is to tailor second-line treatment based on first-line response and continue this into the third line.

View more from the 2013 ASCO Annual Meeting

Robert Figlin, MD, FACP, discusses the sequencing of mTOR inhibitors and tyrosine kinase inhibitors in renal cell carcinoma.

Robert Figlin, MD

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