Management options for patients affected with kidney cancer have changed significantly in the last few years. There have been major advances in genomics, immunotherapy and other treatment modalities, including new surgical approaches, new followup approaches and more.
“Kidney cancer is a disease that nearly all urologic surgeons see and treat,” said W. Marston Linehan, MD, Chief of the Urologic Oncology Branch of the National Cancer Institute. “There are new approaches across the entire spectrum of treatment and new discoveries, many of them in the past 12 months, that are going to impact urologic surgeons’ practice significantly.”
During Friday’s Prime Time plenary session, Dr. Linehan will moderate Tumor Board: Kidney Cancer, which will explore the most recent and the most important changes in the management of kidney cancer. The 30-minute presentation begins at 9:30 am in the Esplanade Ballroom at Moscone South.
Dr. Linehan will be joined in the session by five panelists: Georges Pascal Haber, MD, from the Cleveland Clinic Glickman Urological & Kidney Institute; Robert Uzzo, MD, FACS, Chair of Surgical Oncology and the G. Willing “Wing” Pepper Chair in Cancer Research at Fox Chase Cancer Center; Sandy Srinivas, MD, professor and Clinical Research Group Leader, Urology Program, at Stanford University Medical Center; Sumanta Pal, MD, associate clinical professor of Medical Oncology & Therapeutics Research and Co-director of the Kidney Cancer Program at City of Hope Comprehensive Cancer Center; and Louis Kavoussi, MD, Chair of the Arthur Smith Institute for Urology at Northwell Health, Chair and professor of Urology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
The burden of kidney cancer continues to increase, Dr. Linehan noted. About 300,000 new cases of kidney cancer are diagnosed annually around the world and 100,000 patients die. The increasing incidence is seen especially in older patients.
“Not only are we seeing more older patients, older patients are so much healthier than they used to be that we are thinking about when to manage them surgically and when to observe,” he said. “And some of our new treatments have very low toxicity. Older patients are much more likely to get systemic therapy than ever before.”
Recent advances start with imaging and diagnostics. More tumors are being diagnosed at earlier stages, which has led to new ways to think about managing small renal masses.
In the recent past the primary questions focused on surgical approaches. Today, the questions begin with whether a biopsy is necessary in a particular patient and then what type of management is recommended.
“We have new ways to look at whether surgery is even indicated,” Dr. Linehan said. “If surgery is the appropriate treatment, when do we perform it? We have exciting new approaches for open surgery and when to consider robotic surgery and when we should simply observe the patient.”
Patients with more advanced disease may not be appropriate for observation, but they also have more treatment options than in the past. There are a number of novel immunologic approaches that have produced dramatic responses in patients who had few options for successful treatment just a few years ago.
Surgeons have long debated the relative merits of debulking nephrectomy followed by systemic therapy for patients with advanced disease. There’s no single answer for all patients, but new findings with immunotherapy, including checkpoint inhibitors, are opening up new possibilities for combining surgical debulking with systemic therapy and rendering patients disease-free.
“The role of the urologist is expanding in the management of advanced kidney cancer,” Dr. Linehan said. “The development of new therapies puts the urologist in the middle of treating these patients.”