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Advances in Therapeutic Strategies for Advanced Renal Cell Carcinoma: A Comprehensive Review
Advanced renal cell carcinoma (RCC) accounts for about 2% of cancer deaths globally, and its incidence is increasing in the United States and worldwide.1 Clear cell RCC (ccRCC) comprises about 75% of RCCs and is the most aggressive subtype, although survival rates are substantially improving with the advent of targeted systemic therapies and immune checkpoint inhibitors. In this editorial, I update readers on current therapeutic approaches for patients with advanced RCC, including clear cell and other histotypes. I also review the role of (neo)adjuvant treatment and biomarkers in advanced RCC management.
Pedro Barata, MD, MSc, FACP is a board-certified, fellowship-trained medical oncologist at University Hospitals Seidman Cancer Center and an Associate Professor of Medicine at Case Western Reserve University. Dr Barata serves as the director of the clinical genitourinary medical oncology research program and the co-leader of the genitourinary disease team at Seidman Cancer Center. He is a clinical trialist and his research interests include cancer genomic profiling and novel therapeutics for genitourinary tumors.
The rapid spread of COVID-19 has had dramatic effects throughout the world on healthcare systems with impacts far beyond the patients actually infected with the disease. Patients with severe kidney cancer must rely on data and recommendations as to who can safely defer treatment until after the pandemic is over versus those that should be treated without delay.
Read MoreCancers of the kidney and renal pelvis comprise the sixth most common newly diagnosed tumors in men, the tenth most common in women in the United States, and account for an estimated 65,340 people new diagnoses and 14,970 cancer-related deaths in 2018 in the United States. Despite ongoing stage migration as a result of widespread use of axial abdominal imaging for non-specific abdominal complaints,
Read MoreWith the widespread dissemination of abdominal imaging, there has been a stage migration in kidney cancer. However, this appears to have plateaued since 20071. There remains a significant proportion (~16%) of patients newly diagnosed with renal cell carcinoma who presented with advanced-stage disease and a further subset of those with localized disease are at high risk of recurrence.
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Ulka Vaishampayan delivered the discussant for the preceding two presentations: Subcutaneous nivolumab (NIVO SC) versus intravenous nivolumab in patients with previously treated advanced or metastatic clear cell renal cell carcinoma: Pharmacokinetics, efficacy, and safety results from CheckMate 67T and Belzutifan versus everolimus in participants with previously treated advanced renal cell carcinoma: Patient-reported outcomes in the phase 3 LITESPARK-005 study.
Read MoreSophia Kamran discussed the role of radiation therapy for the management of RCC primary tumors and distant metastatic sites. Dr. Kamran noted that the ‘historical teaching’ is that radiation is not effective for RCC in either the primary or metastatic setting, with radiation primarily reserved for palliative purposes. But in contemporary practice, is RCC radioresistant?
Read MoreDr. Andrea Apolo delivered the discussant for the preceding two late-breaking oral abstract presentations: EV-302/KEYNOTE-A39: Open-Label, Randomized Phase 3 Study of Enfortumab Vedotin in Combination with Pembrolizumab (EV+P) Vs Chemotherapy (Chemo) in Previously Untreated Locally Advanced Metastatic Urothelial Carcinoma (la/mUC), Nivolumab plus gemcitabine-cisplatin versus gemcitabine-cisplatin alone for previously untreated unresectable or metastatic urothelial carcinoma: results from the phase 3 CheckMate 901 trial
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At the 2021 International Kidney Cancer Symposium (IKCS): North America meeting, Dr. Barata presented their work examining gene expression profiling (GEP) in non-clear cell renal cell carcinoma. They employed DNA/RNA next-generation sequencing of tumor samples from the Caris Life Sciences lab. They defined molecular subgroups according to the criteria set out by Motzer et al. and examined 7 clusters.
Read MoreBuilding on the presentations from Dr. Linehan regarding the genetic causes of renal cell carcinoma (RCC) and from Dr. McDermott regarding current and future direction for immunotherapy in RCC, Dr. Srinivasan presented on challenges and emerging strategies for systemic therapy in kidney cancer.
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