Immunotherapy for Metasta c RCC
Immunotherapy in MRCC Pa ents With CNS Metastases
➤ ➤ Evidence regarding management of CNS metastases is inconclusive.
Therefore, proceeding with HD IL-2 in this setting should be individualized,
based on clinical judgment. (A/C)
• Use a VEGFR TKI after local treatment of CNS disease. (47%)
• Treat CNS lesion(s) with either surgery or stereotactic RT first, then consider
proceeding with HD IL-2 if other criteria are met. (40%)
Evalua on of Risk Factor Prognos c Categories in Deciding Whether
to Use IL-2
➤ ➤ Prognostic categories developed to predict survival in patients with mRCC
are used to guide treatment decisions.
• High risk patients with expected poor survival are not considered initial
candidates for HD IL-2. (B/C) Alternative treatments include:
▶ Anti-VEGFR TKI (53%)
▶ Temsirolimus (20%)
▶ Clinical trials, if available (27%)
Dura on of Treatment With HD IL-2 and When to Change Therapy (C)
➤ ➤ Give a second two-week course of therapy to those patients with
responding or stable disease (SD) 12 weeks following HD IL-2. (80%)
➤ ➤ Continue to observe, especially in patients with SD, until progression is
documented, and then start another treatment. (13%)
• There are anecdotal cases of patients who have achieved a durable complete
response (CR) with one course of HD IL-2.
Note: It has not been prospectively evaluated whether patients who have SD
as their best response to the first course of HD IL-2 can achieve either a better
response or delayed progression with additional courses of therapy. However, if
no contraindication exists, the majority of the Task Force would proceed with a
second course before changing treatment.
Progression Following HD IL-2
➤ ➤ Even if response to HD IL-2 lasts at least 6 months:
• proceed to another therapy (73%)
• recommend another course of HD IL-2. (13%)
• resect residual disease if complete removal is feasible. (13%)
• Patients who respond well to two courses of IL-2 but have residual oligometastatic
disease should:
▶ Undergo surgical resection of the residual tumor (73%)
▶ Receive another course of HD IL-2 (20%)
▶ Switch to TKI (7%).
Note: All data were considered anecdotal; patients should be treated according
to clinical judgment.
