DR STADLER: For a lot of these patients, the most difficult conversation — I think that the most important conversation at the beginning really is the conversation of waiting a little bit. There’s very little data that starting with any of these VEGF or mTOR-targeted agents, quote, “earlier” has a survival benefit versus starting later. So I think it’s very important for patients to understand that these drugs, although oral, have real toxicities. And we like to talk about targeted agents, but I’m not convinced that these targeted agents have any less toxicity than our, quote, “cytotoxic” agents and often typically have more.
DR LOVE: Dave?
DR McDERMOTT: I think it’s a hard conversation to have with a patient who’s got growing lesions, that they should wait, although you can make an argument that if you’re going the targeted therapy route, the VEGF/TOR therapy direction, by starting therapy you’re just starting the clock to when they’re eventually going to become resistant. And if the goal is to help them to live as long as possible with a good quality of life, observation makes a lot of sense.
The only areas where we don’t recommend observation off the top are if they’re interested in immune therapy — and we certainly have a bias, some would say too much of a bias — toward immune therapies and IL-2 because, as Walt mentioned, there’s a small, but real chance of a remission of their cancer. They might do better when they have less disease burden.