American Board of Internal Medicine (ABIM) Certification Practice Exam

Which agent can be used with interferon alfa in first-line treatment for metastatic renal cell carcinoma?

1. Axitinib

2. Bevacizumab

3. Sorafenib

4. Temsirolimus

The correct answer is: Bevacizumab

Bevacizumab is an anti-vascular endothelial growth factor (VEGF) monoclonal antibody that inhibits angiogenesis, which is crucial in the treatment of metastatic renal cell carcinoma (mRCC). When used in combination with interferon alfa, bevacizumab has shown improved outcomes in patients by enhancing the body’s ability to combat the tumor through the reduction of blood supply, effectively starving the tumor of necessary nutrients and oxygen. This combination is specifically significant because renal cell carcinoma often relies on angiogenesis for growth and metastasis. The synergistic effect of combining an immunotherapy like interferon alfa, which helps stimulate the immune response, with a targeted therapy like bevacizumab, which addresses the tumor's vascular supply, provides a more comprehensive approach to treatment. In contrast, while agents such as axitinib and sorafenib are also used in the treatment of mRCC, they are typically utilized as monotherapy or in other specific contexts rather than in combination with interferon alfa as a first-line treatment. Temsirolimus, on the other hand, is an mTOR inhibitor that has traditionally been used in a different context, primarily in poor-risk mRCC patients. However, it is not used in conjunction with interferon