SAN FRANCISCO, JANUARY 7-9, 2016
Hello to Kidney Cancer Canada friends,
On behalf of Kidney Cancer Canada, I am happy to share with you some highlights of a recent medical research meeting. The American Society of Clinical Oncology (ASCO) held its annual Genitourinary (GU) Cancers Symposium in San Francisco from January 7-9.
The theme of this year’s Symposium was “Patient-Centric Care: Translating Research to Results”. The program included localized and advanced disease, immunotherapy and health care outcomes. The program was bursting with kidney cancer content including 19 presentations, 129 posters and 2 evening ancillary meetings. It was wonderful to see how much research and progress is being made in kidney cancer, and how it is transforming treatment options for patients.
Please see below for some highlights of the conference from a lay perspective. As always, if you have questions about any of these updates and how they may apply to your care, please feel free to give us a call and, of course, ask your physician.
Key Highlights for Kidney Cancer Patients and Caregivers
New Treatments Providing Additional Hope, Extended Survival
The major news in kidney cancer continues to revolve around the emerging role of immuno-oncology in the treatment of kidney cancer and how this compares to other new agents such as cabozantinib (Cometriq). Key points of discussion:
- A new treatment option for advanced kidney cancer, nivolumab (Opdivo) is now approved in the U.S. by the FDA. Cabozantinib (Cometriq) is currently being reviewed by the FDA based upon strong Phase 3 data. Both of these treatment options have emerged as alternative treatments to either axitinib (Inlyta) or everolimus (Afinitor) in 2nd line treatment. Experts at GU ASCO discussed which treatment options they would prefer for selected patients and why.
Note: nivolumab is currently available to Canadian mrcc patients through compassionate use while it undergoes our review and approvals process. A similar program for cabozantinib is yet to be announced in Canada.
- Existing VEGF/TKI and mTOR treatment options continue to be refined. Experts focused on WHEN and WHY to switch therapies noting that slow disease progression may not warrant a change in therapy. In many cases, “significant toxicity” would not warrant a change by kidney cancer experts familiar with management of side effects. Even new lesions found may be treated with localized therapy and allow for continuation on therapy.
Clinical Trials to Answer Many Unanswered Questions
- Many clinical trials are currently underway to determine whether the current percentage of responders (people who benefit) from an anti-PD1 such as nivolumab (21%) could be increased by combining drugs together. Side effects (toxicities) of some combinations have been noted and need to be carefully weighed against the potential for increased benefit.
- Much is yet to be learned including: How to determine which patients would most likely respond to immuno-oncology (the quest for biomarkers), what combinations of therapies are possible, and whether it is safe to stop the intravenous treatments after a time.
- Reasons NOT to be treated with immuno-oncology included: pre-existing auto-immune diseases or a symptomatic tumour burden
- Overall, experts agreed that clinical trials present the very best option for patients to contribute to this research and potentially benefit from new treatment options.
Note: For information about clinical trials available in Canada, please contact Kidney Cancer Canada at email@example.com
Non-Clear Cell Renal Cell Carcinoma – Can we Do Better for These patients?
- Ram Srinivasan (NIH) presented a strong case for improving treatment options for patients with non-clear cell histologies (papillary, chromophobe, collecting duct) including hereditary kidney cancers. Treatments must be targeted to specific pathways for these subtypes.
- Clinical trials with MET inhibitors, and with combinations such as bevacizumab/erlotinib have produced encouraging results in Papillary mRCC.
Research Posters of Interest
The impact of active smoking on survival outcome in metastatic renal cell carcinoma patients treated with targeted therapy. Research concluded that active smoking diminishes overall survival rates and that smoking cessation should be a counselling priority for all patients on targeted treatments.
Trends of metastasectomy [surgical removal of metastases] for metastatic renal cell carcinoma and their impact on overall survival. Research concluded that in the era of targeted therapies, surgery has perhaps been under-utilized for metastatic rcc, despite offering a proven overall survival benefit. In the U.S., healthcare coverage disparities may be in part responsible.
Thanks to Deb Maskens, Vice Chair, International Kidney Cancer Coalition (IKCC), for her input into this Blog. As always, we welcome your questions, thoughts and insights!
For more information about the whole conference, please see here.
Kidney Cancer Canada