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Case #817
Renal cell Carcinoma

A 64-year-old man with decreased
appetite, weight loss, and left kidney mass

Release Date: April 30, 2009
Expiration Date: April 29, 2010

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Chief Complaint

Decreased appetite and weight loss

History of Present Illness

Arthur was recently admitted to the medical service for a solid left renal mass. Just prior to admission, Arthur presented to his primary care physician with a 3-month history of nausea, decreased appetite, weight loss, constipation and abdominal pain. He had noticed enlargement of his left testicle. He denied hematuria. A non-contrast CT scan of the abdomen was obtained revealing a solid mass in the lower pole of the left kidney measuring 10x7x12 cm. The patient was admitted to the hospital for further evaluation and management of his symptoms.
   
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Disclosures and Important Information


Sponsored by MedCases, LLC

Supported by an educational grant from Wyeth Pharmaceuticals, Inc.

Release Date: April 30, 2009

Expiration Date: April 29, 2010

Estimated time to complete this activity: 2.0 hours

Accreditation Statement

MedCases, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education.

Credit Designation Statement

MedCases designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Statement of Responsibility

MedCases takes responsibility for the content, quality, and scientific integrity of this CME activity.

Course Director and Principal Faculty

Robert A. Figlin, MD
Acting Director and Associate Director for Clinical Research
Comprehensive Cancer Center
Arthur and Rosalie Kaplan Chair in Medical Oncology, Endowed Chair
Chair, Medical Oncology and Therapeutics Research
City of Hope Comprehensive Cancer Center
Duarte, CA

Independent Reviewer

Bernard Escudier, MD
Head, Immunotherapy
Institut Gustave Roussy
Villejuif, France

Target Audience

This activity is intended for medical oncologists, hematologist-oncologists, urologists, pathologists, and allied health care professionals caring for patients with renal cell carcinoma.

Prerequisites

There are no prerequisites.

Statement of Need

Given the availability of multiple treatment options, several questions emerge about how to incorporate these new therapies into the management of metastatic renal cell carcinoma (RCC): Is there an optimal agent, sequence, or combination of therapies? Is there a role for cytokine therapy in the current treatment paradigm for RCC? Are these agents active in nonclear cell RCC? Most importantly, can cure rates be improved with use of these agents earlier in the disease (neoadjuvant or adjuvant therapy)? Ongoing and planned clinical trials hope to provide insight into many of these questions. This educational initiative will provide medical oncologists, hematologist-oncologists, urologists, pathologists, and allied healthcare professionals caring for patients with renal cell carcinoma the opportunity to learn the most recent advances in the treatment of renal cell carcinoma.

Objectives

After completing this activity, you should be able to:

  • Perform the initial evaluation and staging of a patient presenting with renal cell carcinoma
  • Conduct risk stratification required to determine optimal systemic therapy
  • Describe first-line management for patients with advanced renal cell carcinoma
  • Initiate appropriate management of toxicities related to renal cell carcinoma therapies

Method of Participation

This Internet-based activity takes approximately 2 hours to complete. You should review the objectives and cases, answer the multiple-choice posttest, and complete an evaluation form online. Once completed, you will be able to save your certificate to your own computer and print it on your own printer.

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As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is MedCases policy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a provider has with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The following was reported:

Faculty
Bernard Escudier, MD Honoraria: Bayer HealthCare Pharmaceuticals, Novartis Pharmaceuticals Corporation, Pfizer, Inc., Roche, Wyeth Pharmaceuticals
Independent Reviewer
Robert A. Figlin, MD Research Support: Amgen Inc, Antisoma plc, Argos, GlaxoSmithKine, Novartis Pharmaceuticals Corporation, Pfizer Inc, Wyeth Pharmaceuticals
Consultant: Avco, Wyeth Pharmaceuticals
Planning Committee
Ted James, MD; Carolyn Darrow, MPH; and Lillie Chen have indicated that they have not received financial support for consultation, research, or evaluation, and do not have a financial interest relevant to this online activity.

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Non-FDA approved uses of bevacizumab and interferon-alfa are discussed as treatment options based on established clinical practice guidelines from the National Comprehensive Cancer Network (NCCN). Everolimus has not been studied in first-line treatment.

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