Renal cell carcinoma

May occur as part of paraneoplastic syndrome, which occurs in up to 30% of patients. Most often anaemia manifests on presentation of disease, and prognosis is worse. Many paraneoplastic manifestations improve with treatment of the primary disease (early or advanced).

Assessment of anaemia

Before starting treatment, counsel patients and carers on the symptoms of treatment-related adverse effects.[112]National Cancer Comprehensive Network. NCCN clinical practice guidelines in oncology: management of immune checkpoint inhibitor-related toxicities [internet publication]. https://www.nccn.org/guidelines/category_3

Systemic treatment for metastatic disease, particularly with immune checkpoint inhibitors and targeted agents, is often associated with toxicities.[184]Alasker A, Meskawi M, Sun M, et al. A contemporary update on rates and management of toxicities of targeted therapies for metastatic renal cell carcinoma. Cancer Treat Rev. 2013 Jun;39(4):388-401. http://www.ncbi.nlm.nih.gov/pubmed/23317510?tool=bestpractice.com [185]Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Dec;33(12):1217-38. https://www.annalsofoncology.org/article/S0923-7534(22)04187-4/fulltext

Haematological abnormalities (e.g., cytopenias, transaminitis), asthenia, diarrhoea, hand-foot syndrome, pneumonitis, mucositis, and rash have been reported in patients receiving vascular endothelial growth factor tyrosine kinase inhibitors (VEGF-TKIs) and mammalian target of rapamycin (mTOR) inhibitors.[184]Alasker A, Meskawi M, Sun M, et al. A contemporary update on rates and management of toxicities of targeted therapies for metastatic renal cell carcinoma. Cancer Treat Rev. 2013 Jun;39(4):388-401. http://www.ncbi.nlm.nih.gov/pubmed/23317510?tool=bestpractice.com

For patients on immune checkpoint inhibitor therapy, regular clinical monitoring for immune-mediated issues (including colitis, hepatitis, hypophysitis, dermatitis, and thyroiditis) is recommended.[185]Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Dec;33(12):1217-38. https://www.annalsofoncology.org/article/S0923-7534(22)04187-4/fulltext ​ 

Guidelines for monitoring patients on immunotherapies and managing complications are available.[110]Schneider BJ, Naidoo J, Santomasso BD, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. J Clin Oncol. 2021 Dec 20;39(36):4073-126. https://ascopubs.org/doi/10.1200/JCO.21.01440 http://www.ncbi.nlm.nih.gov/pubmed/34724392?tool=bestpractice.com ​[111]Brahmer JR, Abu-Sbeih H, Ascierto PA, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer. 2021 Jun;9(6):e002435. https://jitc.bmj.com/content/9/6/e002435 http://www.ncbi.nlm.nih.gov/pubmed/34172516?tool=bestpractice.com [112]National Cancer Comprehensive Network. NCCN clinical practice guidelines in oncology: management of immune checkpoint inhibitor-related toxicities [internet publication]. https://www.nccn.org/guidelines/category_3 ​​[185]Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Dec;33(12):1217-38. https://www.annalsofoncology.org/article/S0923-7534(22)04187-4/fulltext

May occur as part of paraneoplastic syndrome, which occurs in up to 30% of patients. Most often hypercalcaemia manifests on presentation of disease, and prognosis is worse. Many paraneoplastic manifestations improve with treatment of the primary disease (early or advanced).

Assessment of hypercalcaemia

May occur as part of paraneoplastic syndrome, which occurs in up to 30% of patients. Most often erythrocytosis manifests on presentation of disease, and prognosis is worse. Many paraneoplastic manifestations improve with treatment of the primary disease (early or advanced).

May occur as part of paraneoplastic syndrome, which occurs in up to 30% of patients. Most often SIADH manifests on presentation of disease, and prognosis is worse. Many paraneoplastic manifestations improve with treatment of the primary disease (early or advanced).

Syndrome of inappropriate antidiuretic hormone

Occurs with metastatic disease or Stauffer's syndrome (liver failure due to paraneoplastic syndrome in the absence of liver metastases).

Paraneoplastic syndrome occurs in up to 30% of patients. Most often hepatic dysfunction manifests on presentation of disease, and prognosis is worse. Many paraneoplastic manifestations improve with treatment of the primary disease (early or advanced).

Acute liver failure