WBR0374

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Renal
Prompt	[[Prompt::A 72 year old Caucasian male patient presents to the emergency department complaining of hematuria and back pain of recent onset. The patient’s past medical history is significant for hypertension controlled on pirindopril and diabetes mellitus type II controlled on metformin. Physical examination is significant for a palpable abdominal mass. After appropriate initial work-up, renal biopsy is performed and shows the findings in the image below. If surgical intervention is not possible, which of the following pharmacologic 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 commonly used for hematologic malignancies.
Answer B	AnswerB::Pyrimidine analog that inhibits DNA polymerase
Answer B Explanation	AnswerBExp::Similar to methotrexate, cytarabine, also an antimetabolite, is not effective in 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 Wilms’ tumor and Hodgkin’s lymphoma.
Answer D	AnswerD::Calcineurin inhibitor that binds to FK-binding protein
Answer D Explanation	AnswerDExp::Tacrolimus is a calcineurin inhibitor that binds to FK-binding protein. It 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 pharmacologic therapy for patients with advanced renal cell carcinoma.
Right Answer	RightAnswer::E
Explanation	[[Explanation::Renal cell carcinoma, commonly clear cell carcinoma, is a malignant kidney cancer that originates in the proximal convoluted tubule. In localized disease, partial and radical nephrectomy are both 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 not effective, cytokine recombinant interleukin-2, aldesleukin, has demonstrated clinical efficacy. New therapeutic options, including vascular endothelial growth factor (VEGF) inhibitors and mammalian target of rapamycin pathways have also been showing clinical effectiveness and may be therapeutic options for patients with metastatic renal carcinoma. Educational Objective: Aldesleukin, interleukin 2 recombinant cytokine, has been shown to be an effective pharmacologic therapy for patients with advanced renal cell carcinoma. Reference: Rini, BI, Campbell SC, Escudier B. Renal cell carcinoma. The Lancet. 2009; 373(9669):1119-1132 Educational Objective: References: ]]
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