WBR0374

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Renal
Prompt	[[Prompt::A 72-year-old Caucasian male presents to the ER with complaints of hematuria and back pain. The patient’s medical history is significant for hypertension, controlled with pirindopril, and diabetes mellitus type II, controlled with metformin. Upon physical examination you observe a palpable abdominal mass. After appropriate initial work-up, you preform renal biopsy (the findings are displayed in the image below). If surgical intervention is not possible, which of the following pharmacological therapies is the best treatment modality for the patient’s condition? ]]
Answer A	AnswerA::Folic acid analog that inhibits dihydrofolate reductase
Answer A Explanation	[[AnswerAExp::Methotrexate, an antimetabolite, is not an effective treatment for renal clear cell carcinoma. Methotrexate is frequently used to treat hematologic malignancies.]]
Answer B	AnswerB::Pyrimidine analog that inhibits DNA polymerase
Answer B Explanation	[[AnswerBExp::Cytarabine, an antimetabolite, is not effective in the treatment of renal cell carcinoma.]]
Answer C	AnswerC::Alkaloid that blocks polymerization of microtubule in the M phase
Answer C Explanation	[[AnswerCExp::Microtubule inhibitors, such as vincristine and vinblastine, may be used to treat Wilms tumor and Hodgkins lymphoma.]]
Answer D	AnswerD::Calcineurin inhibitor that binds to FK-binding protein
Answer D Explanation	AnswerDExp::Tacrolimus, a calcineurin inhibitor that binds to FK-binding protein, is commonly used as an immunosuppressive agent for renal transplant recipients.
Answer E	AnswerE::Immune modulation by interleukin-2 recombinant therapy
Answer E Explanation	AnswerEExp::Aldesleukin (interleukin 2 recombinant cytokine) is an effective pharmacological therapy for patients with advanced renal cell carcinoma.
Right Answer	RightAnswer::E
Explanation	[[Explanation::Renal cell carcinoma, also termed clear cell carcinoma, is a malignant kidney cancer originating in the proximal convoluted tubule. In a localized tumor, partial or radical nephrectomy are treatment options, depending on the size of the tumor. Approximately 30% of patients with renal cell carcinoma are initially diagnosed with metastatic disease. While conventional cancer therapy is typically ineffective, cytokine recombinant interleukin-2, (aldesleukin), has demonstrated clinical efficacy. New therapeutic options, such as vascular endothelial growth factor (VEGF) inhibitors and mammalian target of rapamycin pathways, have also demonstrated clinical effectiveness in treating patients with metastatic renal carcinoma. Educational Objective: Cytokine recombinant interleukin-2, (aldesleukin), has demonstrated to be an effective pharmacologic therapy for patients with advanced renal cell carcinoma. References: Rini, BI, Campbell SC, Escudier B. Renal cell carcinoma. The Lancet. 2009; 373(9669):1119-1132]]
Approved	Approved::Yes
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