Hello from Chicago where the ASCO (American Society of Clinical Oncology) conference is now well underway. The big sessions on kidney cancer, including all of the kidney cancer research posters, have not happened yet, but we are happy to share updates as we go. Here’s a mix of what we heard yesterday and this morning:
Non-Clear Cell RCC (Renal Cell Carcinoma): Towards a Consensus, Dr. Nizar Tannir, MD Anderson
Discussed that 15% of rcc cases are non-clear cell, but this group still makes up a very diverse set of cancers including papillary, chromophobe, collecting duct, renal medullary, translocation (xp11), unclassified, and oncoctyoma. Overall recommendation from Dr. Tannir is that ALL patients diagnosed with metastatic non-clear cell rcc should be referred to clinical trials (where available) so that treatment can be targeted to the underlying biology of these very different cancers.
Discussed the use of approved therapies (for clear cell) in the treatment of non-clear cell. In Dr. Tannir’s study of 57 patients taking sunitinib, 0 (zero) patients with papillary rcc responded. Other studies are “all over the map” but show less effectiveness of VEGF-R agents than with traditional (clear cell) rcc. Studies ongoing now (ASPEN, ESPN) are to determine whether everolimus (Afinitor) or sunitinib (Sutent) provide a better response for papillary. Also mentioned Avastin+Tarceva trial at NIH that is specific to papillary.
Summary of what we know today: TKIs are less effective than in clear cell; temsirolimus (Torisel) may be a good option for poor risk patients. Erlotinib (Tarceva) showed some response in Phase 2 study. cMET may be appropriate for those with cMET germline mutation.
Common Concerns of Patients with Cancer
Management of pain. Discussion about use of opioids, opioid-induced constipation. Also “single fraction radiotherapy” (one session) to reduce pain from uncomplicated bone mets. Increasing evidence for vertebroplasty and kyphophlasty for increasing mobility and decreasing pain from bone mets.
Depression in cancer patients: predictors of depression in cancer patients include younger patients, use of anti-depressants at base-line, lower self-esteem and greater physical burden of illness. In patients who are taking TKIs (Sutent, etc.), hypothyroidism and fatigue often mimic depression symptoms. Patients need to be screened for underlying depression. The importance of sleep was well-noted.
Note: Early palliative referral is proven to lead to longer prognoses for advanced cancer patients, in addition to less chemotherapy near end of life. Palliative team experienced in pain management, sleep, depressive symptoms.
Session on Talking to Patients About What is REALLY Important to Them
Patients have fears & concerns: of medical issues (treatment? outcome?), psychosocial worries/sadness, social issues (family, work, future), and spiritual/religious/existential concerns (what is the meaning of cancer to the patient and family?)
Strategies for patients:
- What has worked well for you in the past in stressful situations? What has helped you cope before?
- Patients can use distraction, humour (movies, comedy), talking with others.
- Patients do not have to “be positive” (myth).
- Need to be open to seeking help in coping with the distress.
Interesting comment from an oncologist: the last of the 12 steps in the AA Recovery Program seems to apply to cancer patients as well: “how can I help other people?”. This kind of support given to other patients can be sustaining, and offers a chance to help other people. Good nod given to those who participate in support groups. Yes, this helps us all!
More as it happens… expect news on immunotherapy, more clinical trial results specific to kidney cancer.