This year’s ASCO conference has been a very good one for kidney cancer updates.
In today’s blog post we will summarize yesterday’s session on Cancer Survivorship, followed by today’s early morning session on Kidney Cancer Biology and Treatments.
Great to see several Canadian researchers from Cancer Care Ontario leading discussions on cancer survivorship care, plans, and surveillance strategies. Some key points noted:
– almost all of the literature on survivorship care is about breast cancer. There is an urgent need to better understand survivorship models for other types of cancer sites
– main threat to many of survivors is their co-morbid conditions vs. risk of recurrence
– we need to be careful of overly-aggressive surveillance strategies (in part due to anxiety, false negatives and false positives). We need to use an evidence-based guideline. (Note: for kidney cancer in Canada, we have such a guideline — the CUA guideline for post-nephrectomy.)
– who is primarily responsible for survivorship care? Who will follow the cancer survivor? What survivorship care plan is given by the oncologist/surgeon? Received by the family physician? What is the role of survivorship groups/clinics? Sometimes peer support can lead to positive lifestyle change.
Kidney Cancer Tumour Biology and Treatments
Dr. James Brugarolos presented a very technical presentation that included the role of genome sequencing to identify all of the genes involved in an individual case of kidney cancer. We know that rcc starts with a mutation of the VHL gene, then leads to a chromosome loss and many other mutations. Not all kidney cancer tumours are the same — even within tumours there is a great deal of differentiation that a single biopsy may not detect.
Dr. Danny Heng (from Calgary, Alberta) presented on choices and rationale in first-line treatment. Key points included:
– factors against using an mTOR would be poor pulmonary function, refractory diabetes
– factors against using a VEGF inhibitor would include refractory hypertension, uncontrolled with several meds.
– Choice of first-line therapy comes down to: Oral vs. IV therapy? Toxicity Profiles? Patient Preference (!), Physician Experience, Efficacy**(likely most important consideration), and yes, Reimbursement.
– Cytoreductive Nephrectomy (to remove kidney tumour in the presence of metastatic disease). Advantage seems to be much higher in good/intermediate performance status patients. Clinical trials will report on value of surgical intervention (when there is known metastatic disease) in all types of patients.
Dr. Tony Choueiri, Dana Farber
Presented on treatment after failure of first-line agent. Key points included:
– after cytokine (interleukin, interferon alpha), axitinib data strongest in that setting
– after VEGF, both axitinib and everolimus have “level one” data showing efficacy. The best we can do is an indirect comparison of these two agents. To date there is no solid data on which we could give a preference to one versus the other. The only thing we do know is that the INTORSECT trial (temsirolimus vs sorafenib) in the 2nd line did not show improved overall survival of the mTOR (temsirolimus) in the 2nd line. (It’s perhaps worth noting here that sometimes we need an “unsuccessful” trial to show us what doesn’t improve survival so that we can keep moving forward.)
– Use of PD-1 (BMS/MDX-1106) was suggested as a salvage option for pre-treated patients. Seems to be a very exciting concept offering the next generation of immunotherapy with very low toxicity.
All emphasized the importance of clinical trials so that we can better study the tumour tissue and work towards identifying pre-treatment biomarkers to be able to predict which treatments will work best for the individual patient.
At Kidney Cancer Canada, we will do our best to keep our list of Clinical Trials for RCC in Canada up to date. We are anxiously awaiting new trials to open with the BMS/MDX-1106 drug this fall. In the meantime, we have several important studies underway, including the 3rd line study testing dovitinib vs sorafenib. If you have any questions about clinical trial opportunities, we will do our best to help sort out the information for you.
Signing off from Chicago!
Hope some of this has made sense.
Deb & Catherine