Options in Renal cell cancer treatment

First Line Metastatic disease:
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1.Sutent
2.followed by Nexavar in those who cannot tolerate Sutent
3.Sutent 50   has been equivalent to Lapatinib 800 daily
Other first line Bevacizumab +/- Interferon
Temsorilimus
But if you consider Bevacizumab think of combining to Alezolizumab (there is Synergy)
4.Other 2nd line:
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4.a.  Everolimus
4.b.Cabozantinib

Cabozantinib has been compared to Everolimus
there was a 33 % reduction of dying with Cabozantinib

4.c. Other alternative in 2nd option is Nivolumab which has risen to standard second line after Sutent
Nivolumab has been found superior to Everolimus

4.d  Levantinib
which has been sometime conbined to Everolimus
this combination has been superior to to each drug used separately.

4.e future trial Nivolumab +  Ipilimumab

4.f.  Axitinib

OPTIONS IN TRIPPLE NEGATIVE BREAST CANCER

1.CARBOPLATIN +  VELIPARIB

2.ABRAXANE    +   CARBOPLATIN

3.ADRIAMYCIN  +   CARBOPLATIN    +  TAXANE

WITH TAXANE WEEKLY X12
WHILE CARBOPLATIN IS GIVEN WEEKLY X 6

4LESSER ALTERNATIVE :   GEMZAR  (1000)+  ABRAXANE(125)


5.XELODA



OF NOTE: THE MORE THE NUMBER OF NODES INVOLVED, THE MORE THE BENEFIT OF ANTHRACYCLINS



FOR  METASTATIC DISEASE
1.ADD ENZALUTAMIDE  IN TRIPLE NEGATIVE WHICH HAS AN ADROGEN RECEPTOR POSITIVE, THERE WIL BE A 9 MONTHS BENEFIT

2.TARGETING GLYCOPROTEIN

3.PI3K
USE MTOR INHIBITOR
PACLITAXEL   +   AKT INHIBITOR

4.SNDX
ALEZOLIZUMAB  (1200 )+  ENTINOSTAT:   19%rr

ALEZOLIZUMAB  +  ABRAXANE

5.PARP INHIBITOR
OLEPARIB 400 MG PO BID
RUCAPARIB  600MG PO BID

GENETIC MARKERS AND RELATED MEDICATIONS FOR TREATMENT

IF A TUMOR EXPRESSES

PICA/PTEN--------------------------------------------EVEROLIMUS
TOP3A--------------------------------------------------DOXORUBICIN
PARP1---------------------------------------------------OLIPARIB CISPLATIN
VEGEF--------------------------------------------------BEVACIZUMAB
TYMP----------------------------------------------------XELODA
ROS1-----------------------------------------------------CRIZOTINUB

PROGRESS IN BREAST CANCER TREATMENT

Progress in Breast Cancer treatment:

1. ER Positive

These tumors of course can be treated with Tamoxifen in premenopausal patient (some have required 2 years from last Menses to consider someone Post Menopausal) and Aomatase Inhibitors (AI) for post Menopausal.

In those with recurrent disease (or progression )
Anastrazole or Fulvestran being strong suggestions.
But the game has been improved as more options have been proposed
1.o.   Palbociclib(125) +   Letrozole(2.5)
check day 14 CBC for frequent episode of Neutropenia and fever
time to progression with this combination 22 Vs 14 months

2.o  for the 50% who will not respond to the first option
consider Everolimus + Entinostat
3.o  Everolimus  (10) +  Exemestane

watch for stomatitis,fatigue,Dyspnea,Hyperglucosuria, LFTs, and pneumonitis

4.o   Palbociclib   +   Fulvestran
5.o   Monarch 1 may have proposed Abemaciclib as an option in these instances
6.o   Abemaciclib can be combine with either Letrozole or Fulvestran
7.o   don't forget that Entinostat can also be proposed in combination with Examestane


These same agents can be used in Neoadjuvant setting, when confronted with Locally advanced disease for 16-18 weeks prior to definitive surgery.