A patient taking nivolumab plus cabozantinib for metastatic RCC develops oedema, albumin 22 g/L and urine protein 5.4 g/24 h. Urine sediment is bland

Question

A patient taking nivolumab plus cabozantinib for metastatic RCC develops oedema, albumin 22 g/L and urine protein 5.4 g/24 h. Urine sediment is bland and blood pressure is controlled. What is the most appropriate cabozantinib action?

Accepted Answer

Discontinue cabozantinib and investigate nephrotic syndrome through the renal service

Answer

Withhold nivolumab and continue cabozantinib while arranging a renal biopsy

Answer

Continue cabozantinib at a reduced dose while monitoring albumin weekly

Answer

Stop both agents and start another VEGF-targeted tyrosine kinase inhibitor

Answer

Interrupt cabozantinib, add ramipril and restart once urine protein falls

RCC — SCE Medical Oncology MCQ

A patient taking nivolumab plus cabozantinib for metastatic RCC develops oedema, albumin 22 g/L and urine protein 5.4 g/24 h. Urine sediment is bland and blood pressure is controlled. What is the most appropriate cabozantinib action?