The value of the multidisciplinary team in metastatic renal cell carcinoma: Paving the way for precision medicine in toxicities management

Safety and Adverse Event Management of VEGFR-TKIs in Patients With Metastatic Renal Cell Carcinoma

BACKGROUND

Vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs), alone or in combination with immune checkpoint inhibitors, are part of the standard of care in treating metastatic renal cell carcinoma (mRCC). VEGFR-TKIs are associated with acute, chronic, and potentially dose-limiting toxicities requiring treatment modifications and discontinuations.

OBJECTIVES

This article summarizes evidence-based practices that oncology nurses may use to manage VEGFR-TKI adverse events and improve quality of life in patients with mRCC.

METHODS

Pivotal clinical trial publications of VEGFR-TKIs in mRCC were reviewed to evaluate the adverse event profile of each drug and effective management strategies.

FINDINGS

Patients with mRCC treated with VEGFR-TKIs can benefit from education about potential side effects, consistent monitoring, and early detection of adverse events, as well as appropriate interventions to improve treatment tolerability, adherence, outcomes, and quality of life.

Platinum-based chemotherapies-induced nephrotoxicity: mechanisms, potential treatments, and management

Platinum-based chemotherapies are essential in the treatment of several malignancies. However, such medications can damage the kidneys, frequently leading to both acute and chronic kidney disease. Treatment becomes more difficult for such problems. Physicians may alter chemotherapy regimens and utilize kidney-protecting medications to lessen renal damage. New imaging techniques and biomarkers also aid in the early detection of renal issues. To effectively handle the mentioned situation, oncologists, nephrologists, and pharmacists must collaborate. However, additional study is still required to develop customized therapies, discover strategies to minimize kidney injury and produce new platinum medicines. Hereupon, the present review's authors are being sought to address the causes, prospective treatments, and management of nephrotoxicity caused by platinum-based chemotherapy.

Repeat robotic nephron-sparing surgery for metachronous multifocal tumors in a solitary kidney: a case report

We report the case of a 58-year-old male with metachronous renal tumors and a solitary kidney who had previously undergone an open right radical nephrectomy with extended lymphadenectomy for an invasive renal cell carcinoma (RCC) (pT3a N0M0) in November 2013. In May 2022, during routine surveillance, a left lower pole lesion measuring 2.5 × 2 × 1.6 cm was detected, and the patient was submitted to robot-assisted partial nephrectomy (RAPN). The histopathological study confirmed the presence of a pT1a Fuhrman grade 3 clear cell renal carcinoma. In October 2024, follow-up imaging revealed a new upper pole lesion measuring 4 × 3 × 2.3 cm in the left kidney. The patient was submitted to a novel robot-assisted partial nephrectomy, which was successfully completed using selective clamping of the renal artery. The clamping time was 28 minutes (versus 17 minutes during the initial procedure), and the estimated blood loss increased to approximately 300 mL compared to about 100 mL previously, with a console time of 98 minutes. The patient was discharged after the second surgery in good functional status. The final pathology revealed clear cell RCC, Fuhrman grade 2/nucleolar grade 2 (WHO/ISUP 2016), and pT1a, with negative margins. Despite increased technical challenges during reoperation, postoperative renal function remained stable, underscoring the feasibility of repeat RAPN in a solitary kidney.

The spectrum of cutaneous toxicities related to novel genitourinary cancer therapies

CONTEXT

Genitourinary cancers (GUCs) encompass malignancies affecting the urinary and reproductive systems, including renal cell carcinoma (RCC), urothelial carcinoma (UC), and prostate cancer (PC). With the rapidly evolving therapeutic domain of these cancers, cutaneous adverse events (AEs) remain among the most observed toxicities.

OBJECTIVE

To explore the dermatologic AEs linked to novel GUC treatments, their underlying pathophysiology, clinical presentations, and risk factors.

EVIDENCE ACQUISITION

A narrative review of the literature from PubMed and Embase databases was conducted. The search strategy included dermatologic/cutaneous adverse events, risk factors, and pathophysiology in conjunction with the following classes of therapies; immune checkpoint inhibitors (ICIs), antiangiogenic therapies, enfortumab vedotin (EV), erdafitinib, and androgen receptor antagonists (ARAs).

EVIDENCE SYNTHESIS

Maculopapular rash, pruritus, and alopecia are present among the five classes of therapies. ICIs demonstrate the highest incidence of severe drug AEs including Steven Johnson syndrome/toxic epidermal necrolysis. Unique cutaneous AEs present with specific therapies including hand-foot skin reaction and subungual splinter hemorrhage with antiangiogenic drugs, stomatitis/mucositis and onycholysis with erdafitinib. Incidence and type of cutaneous AE also differed within therapies in the same class as seen with apalutamide displaying the highest risk of cutaneous AEs within ARAs. Risk factors for development of cutaneous AEs can be general to therapies, or specific, and include age, immune status, BMI, and gender.

CONCLUSIONS

Dermatologic AEs may impact patients' quality of life and increase the tendency to dose reduce, hold or discontinue life-saving therapies, underscoring the need for vigilant monitoring, early recognition, and collaborative management between medical oncologists, pharmacists, dermatologists and other specialists.

Prevalence and management of proteinuria associated with vascular endothelial growth factor receptor-targeted tyrosine kinase inhibitor treatment in advanced renal cell carcinoma, hepatocellular carcinoma, and thyroid cancer

Vascular endothelial growth factor receptor-targeted tyrosine kinase inhibitors (VEGFR-TKIs) are often used for treatment of several types of cancer; however, they are associated with an increased risk of proteinuria, sometimes leading to treatment discontinuation. We searched PubMed and Scopus to identify clinical studies examining the incidence and risk factors for proteinuria caused by VEGFR-TKIs in patients with renal cell carcinoma, thyroid cancer, and hepatocellular carcinoma. The global incidence of proteinuria ranged from 6% to 34% for all grades of proteinuria, and from 1% to 10% for grade ≥3 proteinuria. The incidence of proteinuria did not differ significantly by cancer type, but in all three cancer types, there was a trend toward a higher incidence of proteinuria with lenvatinib than with other VEGFR-TKIs. In terms of risk factors, the incidence of proteinuria was significantly higher among Asians (including Japanese) compared with non-Asian populations. Other risk factors included diabetes mellitus, hypertension, and previous nephrectomy. When grade 3/4 proteinuria occurs, patients should be treated according to the criteria for dose reduction or withdrawal specified for each drug. For grade 2 proteinuria, treatment should be continued when the benefits outweigh the risks. Referral to a nephrologist should be considered for symptoms related to decreased renal function or when proteinuria has not improved after medication withdrawal. These management practices should be implemented universally, regardless of the cancer type.