Renal cell carcinoma management: real-world practice and challenges at a national level

Abstract

Renal cell carcinoma (RCC) management has seen a revolution over the last decades. Six Lebanese oncologists discussed recent updates in RCC management and outlined the challenges and future directions in Lebanon. Sunitinib continues to be a first-line choice for metastatic RCC in Lebanon, except for intermediate- and poor-risk patients. Immunotherapy is not always accessible to patients or selected routinely as first-line therapy. More data are needed on the sequencing of immunotherapy and tyrosine kinase inhibitor treatments and on the use of immunotherapy beyond progression and/or after failure of immunotherapy in the first-line setting. For second-line management, the clinical experience with axitinib for low tumor growth rate and nivolumab after progression on tyrosine kinase inhibitors make those two agents the most widely used. Several challenges affect the Lebanese practice, limiting the accessibility and availability of the medications. Reimbursement remains the most critical challenge, especially with the socioeconomic crisis of October 2019.

Tweetable abstract

Management of renal cell carcinoma in Lebanon

Keywords::

• checkpoint inhibitors
• combination
• immunotherapy
• renal cell carcinoma
• tyrosine kinase inhibitors

Author contributions

M Ghosn: conceptualization, writing (review and editing), supervision. J Kattan: conceptualization, writing (review and editing), supervision. F El Karak: writing (review and editing). H Ghanem: writing (correspondent author, review and editing). J Debs: writing (review and editing). K Chouaib: writing (review and editing). K Ibrahim: writing (review and editing). A Shamseddine: conceptualization, writing (review and editing), supervision.

Financial & competing interest disclosure

M Ghosn, J Kattan, F El Karak, H Ghanem, K Ibrahim and A Shamseddine were paid consultants to Pfizer during the expert meeting in connection with the development of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Medical writing support was provided by C Abou Selwan, Science PRO s.a.r.l, Lebanon, and was funded by Pfizer.

Additional information

Funding

M Ghosn, J Kattan, F El Karak, H Ghanem, K Ibrahim and A Shamseddine were paid consultants to Pfizer during the expert meeting in connection with the development of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.