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Scott Tykodi, MD, PhD
ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified) )| Communities: Kidney and Renal Cancer , Melanoma (Cutaneous) | Answers: 8 |
| Member Since: Sep. 2012 |
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Professional Statement
Dr. Scott Tykodi is Assistant Professor in the Division of Medical Oncology at the University of Washington and Assistant Member at the Fred Hutchinson Cancer Research Center in Seattle, Washington.
As a medical oncologist and lead investigator, Dr. Tykodi’s clinical focus is in the application of immune therapies to treat kidney cancer and melanoma. His clinical expertise includes the application of hematopoietic cell transplantation, high dose interleukin-2, and cancer vaccines to the treatment of advanced kidney cancer. More recently, Dr. Tykodi has led clinical trials at his center studying the emerging class of immune check point inhibitors for treating kidney cancer, melanoma, and other cancers.
As a medical oncologist and lead investigator, Dr. Tykodi’s clinical focus is in the application of immune therapies to treat kidney cancer and melanoma. His clinical expertise includes the application of hematopoietic cell transplantation, high dose interleukin-2, and cancer vaccines to the treatment of advanced kidney cancer. More recently, Dr. Tykodi has led clinical trials at his center studying the emerging class of immune check point inhibitors for treating kidney cancer, melanoma, and other cancers.
Professional Info
Credential: MD
Primary specialty: Oncology - Hematology/Oncology
Medical school: Washington University, St. Louis, MO
Residency: Barnes-Jewish Hospital, Washington University
Fellowship: University of Washington/Fred Hutchinson Cancer Research Center
Areas of expertise: Cancer immunotherapy; renal cell carcinoma; hematopoietic cell transplantation; clinical trials.
Hospital affiliation: Seattle Cancer Care Alliance
Practice address:
825 Eastlake Ave E, G4810
Seattle, WA
98109
Practice phone number: 206.288.7341
ScottTykodiMDPhD Activities
The most common site of spread of kidney cancer is to the chest or lungs. Other common sites include bone, lymph nodes, liver, and adrenal glands. Brain involvement is also possible. Metastatic disease in bone and brain deserve additional comment. Tumor involving bone is an indication for treatment with a bisphosphonate such as zoledronic acid (Zometa) or RANK ligand inhibitor denosumab (Xgeva) (in addition to a cancer-specific therapy) to decrease the rate of new bone tumor formation and symptoms associated with bony tumor. Brain involvement is typically managed by radiation therapy as either whole brain irradiation or stereotactic radio-surgery (gamma-knife radiation).
Metastatic spread of RCC occasionally presents with a single discrete tumor amenable to surgical removal or definitive stereotactic body radiation therapy. Although such treatment is not expected to be curative, retrospective reports of patients able to undergo metastectomy to remove all sites of cancer suggest better overall survival. Patients rendered “disease free” in this manner would typically be followed with periodic observation. As discussed above, there are no approved adjuvant treatments for RCC that might be applied in the completely resected stage IV setting.
Metastatic spread of RCC occasionally presents with a single discrete tumor amenable to surgical removal or definitive stereotactic body radiation therapy. Although such treatment is not expected to be curative, retrospective reports of patients able to undergo metastectomy to remove all sites of cancer suggest better overall survival. Patients rendered “disease free” in this manner would typically be followed with periodic observation. As discussed above, there are no approved adjuvant treatments for RCC that might be applied in the completely resected stage IV setting.
New answer by ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
6 months ago
Sunitinib has been the most commonly prescribed drug for first line treatment of metastatic clear cell RCC and is administered in 4 week on / 2 week off treatment cycles. In my clinic, I discuss with patients the common side effects they may experience like GI toxicity (mouth soreness, diarrhea), skin toxicity with hand foot syndrome, fatigue, and hypertension that may require medical therapy. We discuss less common but more medically serious side effects like increased risk of blood clots, new onset heart failure, bowel injury, or liver toxicity. And we discuss lab abnormalities we will be checking for including thyroid dysfunction, and low blood counts. Most importantly, I like to see patients for a clinic follow up 2 weeks into their first treatment cycle. I find side effects will creshendo over the 4 week treatment interval. Patients with moderate symptoms at 2 weeks invariably will need a dose adjustment or treatment holiday to complete the first therapy cycle. Once we have established their tolerance for sunitinib including dose modifications, I typically see patients once per 6 week cycle.
New answer by ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
6 months ago
Currently, there are no approved adjuvant therapies for completely resected RCC and the standard of care remains observation. However, several agents have undergone testing in recent years in this setting and results have yet to be reported. Agents under study include the monoclonal antibody girentuximab (Rencarex) that targets the carbonic anhydrase IX protein on clear cell RCC tumors, and several antiangiogenic therapies including the TKI’s sunitinib, sorafenib, pazopanib, and the mTOR inhibitor afinitor. Adjuvant studies with pazopanib and afinitor are presently ongoing and available to patients with newly diagnosed high risk RCC.
New answer by ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
6 months ago
Cytotoxic chemotherapies have been extensively explored for RCC and failed to show a survival benefit. For their global lack of efficacy, they are rarely tried in RCC patients. However, for certain RCC subpopulations, chemotherapy may still play a role. Patients with extensive sarcomatoid differentiation of their tumors, patients with rapidly progressive tumors, and rare RCC subtypes including medullary and collecting duct tumors may be preferentially treated by chemotherapy.
New answer by ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
6 months ago
For good or intermediate risk patients (see discussion fromhttp://talkabouthealth.com/for-kidney-cancer-patients-what-can-be-learned-from-blood-tests-and-what-in-particular-are-you-watching-for) with metastatic clear cell RCC, results of randomized phase III clinical trials support a choice for first line anti-angiogenic (vascular endothelial growth factor (VEGF) pathway targeted therapy) between the oral tyrosine kinase inhibitors (TKI’s) sunitinib or votrient versus the combination of bevacizumab, given by iv infusion every two weeks, paired with IFN administered as a subcutaneous injection three times weekly. Outcomes of separately conducted studies with sunitinib, pazopanib and the bevacizumab/IFN combination are not sufficiently different to suggest a preferred agent. For my own patients, I see a definite preference for the oral agents that generally require less frequent clinic visit and allow a more flexible schedule than for bevacizumab/IFN. Many patients travel significant distances to be evaluated and treated at our center, or prioritize travel and vacation plans with the knowledge they have an incurable cancer and appreciate the convenience of the oral agents.
Results from head to head trials of pazopanib versus sunitinib (the PISCES and COMPARZ trials) have been reported in 2012. Key findings demonstrated statistically equivalent anti-tumor efficacy for the two TKI’s with a side effect profile favoring pazopanib. These emerging comparative results may sway providers to recommend pazopanib as a preferred agent over sunitinib for primary therapy of clear cell RCC.
For poor risk RCC patients, temsirolimus is the preferred agent based on a phase III study (the ARCC trial) demonstrating a survival benefit for temsirolimus versus IFN in this patient population.
There is less clinical data to guide therapy choices for non-clear cell RCC tumors. Subgroup analysis of the ARCC study of temsirolimus versus IFN demonstrated a survival benefit in non-clear cell histologies. Although the study only enrolled poor risk patients, I generally view mTOR inhibitors as the drug class of choice for first line treatment of non-clear cell RCC, recognizing good performance patients will inevitably receive TKI’s in the second line. Retrospective and subgroup analyses suggest TKI’s have less potency for non-clear cell RCC tumors than for the clear cell histology. An ongoing comparative study of the oral mTOR inhibitor everolimus versus sunitinib as first line treatment for non-clear cell RCC will help to define the best available agent for these patients.
Results from head to head trials of pazopanib versus sunitinib (the PISCES and COMPARZ trials) have been reported in 2012. Key findings demonstrated statistically equivalent anti-tumor efficacy for the two TKI’s with a side effect profile favoring pazopanib. These emerging comparative results may sway providers to recommend pazopanib as a preferred agent over sunitinib for primary therapy of clear cell RCC.
For poor risk RCC patients, temsirolimus is the preferred agent based on a phase III study (the ARCC trial) demonstrating a survival benefit for temsirolimus versus IFN in this patient population.
There is less clinical data to guide therapy choices for non-clear cell RCC tumors. Subgroup analysis of the ARCC study of temsirolimus versus IFN demonstrated a survival benefit in non-clear cell histologies. Although the study only enrolled poor risk patients, I generally view mTOR inhibitors as the drug class of choice for first line treatment of non-clear cell RCC, recognizing good performance patients will inevitably receive TKI’s in the second line. Retrospective and subgroup analyses suggest TKI’s have less potency for non-clear cell RCC tumors than for the clear cell histology. An ongoing comparative study of the oral mTOR inhibitor everolimus versus sunitinib as first line treatment for non-clear cell RCC will help to define the best available agent for these patients.
New answer by ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
6 months ago
For RCC patients with apparent metastatic disease present at diagnosis, the question of whether the patient should undergo a debulking nephrectomy surgery on the primary kidney tumor is frequently a point of discussion. Randomized clinical trials conducted in both Europe and the US and reported in 2001 demonstrated a survival benefit for RCC patients treated by initial debulking surgery. However, at the time these studies were conducted, most patients were subsequently treated with interferon alfa as the standard medical therapy for RCC at the time. The evolution of the medical management for RCC has created uncertainty as to whether similar benefit would be realized in patients treated with contemporary anti-angiogenic targeted agents. Although clinical trials are underway to evaluate the role of nephrectomy in patients treated with sunitinib, results won’t be known to patents and providers for the next few years.
Considering the historical data showing a survival benefit with debulking nephrectomy surgery, our clinic commonly recommends nephrectomy surgeries to newly diagnosed RCC patients. Additional clinical factors that come into play that favor initial debulking nephrectomy include patient symptoms from the primary tumor that would be palliated by surgery, removal of the majority of tumor burden by nephrectomy and the observation that most of the patients treated in phase III registration trials defining the activity of targeted agents had undergone prior nephrectomy. Alternatively, patients symptomatic from sites of metastatic disease who are likely to suffer clinical deterioration by delaying systemic therapy are usually counseled against surgery.
Considering the historical data showing a survival benefit with debulking nephrectomy surgery, our clinic commonly recommends nephrectomy surgeries to newly diagnosed RCC patients. Additional clinical factors that come into play that favor initial debulking nephrectomy include patient symptoms from the primary tumor that would be palliated by surgery, removal of the majority of tumor burden by nephrectomy and the observation that most of the patients treated in phase III registration trials defining the activity of targeted agents had undergone prior nephrectomy. Alternatively, patients symptomatic from sites of metastatic disease who are likely to suffer clinical deterioration by delaying systemic therapy are usually counseled against surgery.
New answer by ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
2
Answers |
6 months ago
At the time a diagnosis of metastatic (stage IV) RCC is made, several routine laboratory tests have been shown to be prognostic. Low hemoglobin, high calcium, and high LDH (in addition to the time from RCC diagnosis to therapy and performance status) were identified by investigators at the Memorial Sloan Kettering Cancer Center (MSKCC) as independent prognostic factors associated with survival of RCC patients. These factors can be used to divide patients into good (0 risk factors), intermediate (1 or 2 risk factors), and poor risk groups (≥ 3 risk factors). This prognostic algorithm remains the most widely used and importantly, may also impact the choice of initial therapy applied to metastatic RCC. The drug temsirolimus was studied as initial therapy for poor risk RCC patients and showed a survival benefit versus interferon alfa (IFN). Based on this study, temsirolimus is generally considered the drug of choice for the poor risk patient subset.
Other laboratory tests that may also be prognostic at the time of diagnosis include elevated C-reactive protein (CRP) levels, and elevated neutrophil or platelet counts.
Other laboratory tests that may also be prognostic at the time of diagnosis include elevated C-reactive protein (CRP) levels, and elevated neutrophil or platelet counts.
New answer by ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
6 months ago
Medical oncology consultation is commonly sought following a nephrectomy surgery for a kidney tumor. In adults, the most common type of primary kidney cancer is a renal cell carcinoma (RCC). Clear cell (~70%) and papillary (~20%) are the most common subtypes of RCC. Patients with these tumors are typical for our Kidney Cancer Clinic.
There are several issues commonly discussed with the newly diagnosed RCC patient. First, although most RCC tumors are sporadic, syndromes associated with inherited gene abnormalities that predispose to a high risk for developing RCC tumors have been identified. A careful family history to identify other family members with kidney tumors is part of the initial evaluation. Patients with a concerning family pedigree for RCC are referred for genetics consultation. Second, there are no established adjuvant therapies for completely resected RCC. However, several newly available “targeted therapies” for treating advanced RCC are currently undergoing study as adjuvant treatments including sorafenib, sunitinib, pazopanib and everolimus. For eligible patients, a discussion of participation in an adjuvant clinical trial would be an important part of the first meeting. Finally, the standard of care for completely resected RCC is observation. However, definitive data on the optimal screening interval and type of imaging is generally lacking. Recommendations are tailored to individual patients dependent on their relative risk of tumor recurrence, abnormal findings on baseline imaging studies, and medical comorbidities among other factors. Regarding imaging studies, I am often asked about PET imaging for RCC. A significant fraction of RCC tumors won’t take up FDG-glucose and can’t be visualized by PET imaging. Given the poor sensitivity, PET is not a standard imaging tool for RCC.
There are several issues commonly discussed with the newly diagnosed RCC patient. First, although most RCC tumors are sporadic, syndromes associated with inherited gene abnormalities that predispose to a high risk for developing RCC tumors have been identified. A careful family history to identify other family members with kidney tumors is part of the initial evaluation. Patients with a concerning family pedigree for RCC are referred for genetics consultation. Second, there are no established adjuvant therapies for completely resected RCC. However, several newly available “targeted therapies” for treating advanced RCC are currently undergoing study as adjuvant treatments including sorafenib, sunitinib, pazopanib and everolimus. For eligible patients, a discussion of participation in an adjuvant clinical trial would be an important part of the first meeting. Finally, the standard of care for completely resected RCC is observation. However, definitive data on the optimal screening interval and type of imaging is generally lacking. Recommendations are tailored to individual patients dependent on their relative risk of tumor recurrence, abnormal findings on baseline imaging studies, and medical comorbidities among other factors. Regarding imaging studies, I am often asked about PET imaging for RCC. A significant fraction of RCC tumors won’t take up FDG-glucose and can’t be visualized by PET imaging. Given the poor sensitivity, PET is not a standard imaging tool for RCC.
New answer by ScottTykodiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
6 months ago
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