Kidney Cancer

“As other factors such as access to care, socioeconomic conditions, patient preference, and other unknown confounders might have played a role in the observed disparity, it is still unclear whether overestimating the postoperative eGFR of Black patients contributes to the lower use of nephron-sparing approaches in this population,” the authors write.

"Augmented biopsy-based and noninvasive options are available to reduce benign resection rates of renal tumors with the consideration of PEER and 99mTc-sestamibi SPECT/CT," writes Hiten D. Patel, MD, MPH.

As the year comes to a close, we revisit some of this year’s top content on kidney cancer.

The FDA’s Fast Track Designation is designed to expedite the review and development of novel treatments that will fill an unmet medical need.

"What was surprising to me is that the incidence [of kidney cancer] has leveled off over the past 2 years," says Laura Bukavina, MD, MPH.

“Due to the rarity and poor molecular characterization of nccRCC, there is an underrepresentation in clinical trials evaluating patients with this type of RCC; because of this, patients are often treated with non-tailored therapies,” the researchers wrote.

Findings shared during the 2022 International Kidney Cancer Symposium showed that patients with advanced renal cell carcinoma treated upfront with pembrolizumab plus lenvatinib were far less likely to need second-line therapy vs patients receiving first-line sunitinib.

The updated results were shared at the 2022 International Kidney Cancer Symposium.

"Up-front CN is associated with a survival benefit in selected patients with mRCC treated with either targeted therapy or ICI therapy," writes Badar M. Mian, MD.

Rana McKay, MD, says the CheckMate-214, KEYNOTE-426, CheckMate-9ER, and CLEAR trials have revolutionized the first-line treatment paradigm in advanced renal cell carcinoma.

“There has never been a clinical trial for these patients. It is unclear whether these patients should be treated with medication, surgery, or another approach. This represents an unmet medical need,” said Raquibul Hannan, MD, PhD.

The focus of the analysis was to determine the HRQOL of patients who were enrolled on the phase 3 KEYNOTE-426 trial.

Patients in the CheckMate-914 trial had received radical or partial nephrectomy and were at moderate or high risk of relapse.

“Survival differences can be due in part to genetic differences, but also a lot of socioeconomic issues as well,” says Ridwan Alam, MD.

Ridwan Alam, MD, discusses research exploring nonclinical factors affecting overall survival in patients with renal cell carcinoma.

Exelixis plans to discuss the top level results of the phase 3 COSMIC-313 trial with the FDA regarding a potential application submission for the triplet in this setting.

“One of the processes that is regulated by HIF2α is angiogenesis,” says James Brugarolas, MD, PhD.

Understanding the mechanisms of treatment resistance is among the areas of unmet need, says James Brugarolas, MD, PhD.

Tivozanib (Fotivda) is approved by the FDA for the treatment of adult patients with relapsed or refractory advanced renal cell carcinoma who have received 2 or more prior systemic therapies.

“We use a lot of clinical characteristics, but I’m hopeful we will start to go into more molecular typing and gene signatures,” says Tian Zhang, MD.

Analysis is one of the largest-ever series of outcomes for patients with renal masses in a solitary kidney.

The study specifically examined this precision medicine pathway in the context of frontline treatment selection between nivolumab with or without ipilimumab and a VEGFR tyrosine kinase inhibitor.

Combination therapy with the novel TKI sitravatinib and the anti–PD-1 immune checkpoint inhibitor nivolumab showed promising efficacy and safety in patients with clear cell renal cell carcinoma and progression after antiangiogenic therapy.

Surgical approach and ischemia time are among key topics.

"Cryotherapy was the first energy source that we were able to ablate tissues with in either the kidney or prostate and understand what that ablation would do," says J. Stephen Jones, MD, FACS.

“The question of who is a candidate for active surveillance is hard to answer because this is a bedside, gut decision," says Primo Nery Lara, Jr, MD.

Gennady Bratslavsky, MD highlighted studies examining (neo)adjuvant immunotherapy in the setting of nephrectomy for locally advanced disease, such as the PROSPER (NCT03055013) and KEYNOTE-564 (NCT03142334) trials.

“One of the reasons I so enjoy this conference is the multidisciplinary nature,” says Peter A. Humphrey, MD, PhD.

“There are, indeed, numerous paths that we are trying to tackle from different angles,” says Gennady Bratslavsky, MD.