According to Robert G. Uzzo, MD, kidney cancer treatment is defined by a “virtuous cycle” where basic science informs drug development, which guides clinical practice, which feeds back to basic researchers.
“Most urologists believe that translational science is important to the medical oncologist or those managing stage IV kidney cancer,” said Dr. Uzzo, professor and Chair of Surgical Oncology at the Fox Chase Cancer Center/Temple University Health System. “But the truth is this virtuous cycle, whose kinetics are rapid, is extremely important to the urologist because it has growing implications for patients with localized disease, particularly the incidental small renal mass.”
Dr. Uzzo will moderate a panel discussion during Tuesday’s Plenary I program, titled Stratifying Care of the Small Renal Mass: From Bench to Bedside and Back. The 25-minute panel discussion begins at 9 a.m. in Hall A in the San Diego Convention Center. The session’s panelists will review risk stratification of small renal masses using radiology, biopsy and biomarkers.
“New research and multiple trials using quantitative radiology are delineating techniques of an imaging biopsy with increasing sensitivity and specificity to guide management,” Dr. Uzzo said. “So it’s quickly becoming no longer a matter of whether the lesion is simply solid or cystic anymore.”
Dr. Uzzo said the discussion about needle biopsy has moved from “tell me why we should” toward “tell me why we shouldn’t.”
“In as many as half or more small renal masses, a biopsy provides valuable and potentially actionable risk stratifying data,” he said. “It’s no longer acceptable to routinely ‘take it out and see,’ particularly in the elderly or infirmed.”
Biomarkers also have the potential to complete the virtuous cycle of discovery and development for localized renal cell carcinoma.
“Genomic and epigenomic profiles of histologic subtypes of renal cancer are well described, and in only a short time these data will translate into clinically meaningful predictive tools for small renal masses, recapitulating the paradigm shifts that have occurred in stage IV disease,” Dr. Uzzo said.
“It has been a complete about-face in the way we treat advanced disease,” he continued. “That same sort of rapid evolution of thinking has got to occur, and will occur, in patients with small renal masses.”
Dr. Uzzo said the last decade has produced an unprecedented number of new treatments, including an “explosion of new therapies with level 1 evidence to support their use, and more are coming.”
This acceleration of innovation and knowledge is building on basic science from the late 1980s and early 1990s led by urologists in the field of kidney cancer. And though kidney cancer researchers are far ahead in understanding the molecular biology of renal tumors, urologists lag behind other fields in their use of predictive biomarkers, Dr. Uzzo said.
All of these advances mean the discussion between the patient and urologist regarding incidental renal masses will no longer automatically jump to surgical options.
“With the insertion of quantitative radiology, the use of needle biopsy to stratify risk and almost certainly an emerging role for biomarkers, the conversation between the initial scan and the next step is about to get far more complicated,” Dr. Uzzo said.
Plenary I Preview
Stratifying Care of the Small Renal Mass: From Bench to Bedside and Back
Moderator: Robert G. Uzzo, MD
9 – 9:25 a.m. Tuesday
Hall A, San Diego Convention Center