Clinical Pearls for Community Oncologists Treating RCC


Expert genitourinary oncologists close their discussion with advice to community oncologists treating renal cell carcinoma.


Elizabeth Wulff-Burchfield, MD: I’d love to get one last word from everybody. When you think about managing anything we’ve talked about—intermediate or poor risk, up front or sequencing of subsequent therapies, toxicity—is there any pearl you wish you’d known before that’s unique to treating a lot of kidney cancer? Is there anything you think we should share with our colleagues who don’t see as much kidney cancer? Dr Barata, is there anything that you think is a key takeaway?

Pedro Barata, MD: Yes, a couple of things. One is that our conversation was focused on clear cell [carcinoma]. Non–clear cell is completely different. When we see 2 or 3 cases a year, we need to keep that in mind that the options and discussion are different. Our conversation was around clear cell RCC [renal cell carcinoma], and it’s relevant. For most patients we see, they probably should be offered an I/O [immuno-oncology]–based approach. Risk scores, like the IMDC [International Metastatic RCC Database Consortium], should be part of our initial management of those patients before we decide what to do. We should understand their risk. Sites of metastases, tumor burden, presence of sarcomatoid rhabdoid features, presence of symptoms, how quickly disease progresses, and pace of progression are relevant points that impact our decision about what to do. The field is evolving rapidly, meaning it’s hard to keep up. It’s great news for patients. As we treat more, we’ll be more experienced managing some of the adverse events, so patients live longer but also live better.

Elizabeth Wulff-Burchfield, MD: Thank you so much. Dr McGregor, any other takeaways or pearls that you’d like to share?

Bradley McGregor, MD: The advances we made in kidney cancer are dramatic. How far we’ve come in the past 5 years is unparalleled. When we think about metastatic cancer, we often think this is an incurable situation, but for a subset of patients with our therapies, we may be curing patients. We may be giving them a prolonged treatment-free interval. That’s incredibly exciting. I hope we can do that more through the current trials. But as we think about how we treat kidney cancer, there are a lot of doublets out there. The most important thing is that if you’re overwhelmed, there are a lot of great data, and the experts are overwhelmed. That’s why they don’t give you a clear answer on NCCN [National Comprehensive Cancer Network] Guidelines. As long as you discuss [options] with your patients and look at a doublet-based therapy, you can’t go wrong with the treatment of kidney cancer.

Elizabeth Wulff-Burchfield, MD: Thank you. Dr McKay, can you round us out? What’s your parting wisdom?

Rana McKay, MD: I echo the thoughts of my colleagues. It’s incredible. In just over a decade, we’ve seen the survival for kidney cancer improve from less than a year to 4 or 5 years for patients who have advanced disease. That’s tremendous. We’re talking about new end points that are clinically meaningful, like treatment-free survival, which we never talked about in the past. We’ve come a long way, but my hope is that we can continue to figure out how to maximize the benefit of therapy for every patient. How do we optimize treatment selection and be a little more elegant in our selection of therapy based on evolving biomarkers? How do we improve the tail of the curve? How can we have it so that patients with this disease have long, durable remissions or responses to therapy? We’ve come a long way. It’s exciting.

Elizabeth Wulff-Burchfield, MD: Thank you. The other concrete thing I’ll mention, to summarize some of what you all have shared, is that given the CONTACT-03 data, all of us would be hesitant to continue I/O therapy for patients who’ve had clear radiographic or clinical progression on that first-line I/O-containing regimen because the data supporting its benefit is in question more than ever. More to come, but that’s important because there’s been so much variability in what I see colleagues from all types of practices doing. It was meaningful to hear how hesitant you are in the way that I am.

Thank you to all 3 of my esteemed panelists and trusted colleagues for your time and wisdom. I appreciate you sharing your interpretations of things, given how nuanced everything is and how hard it is for all of us to sort through things. To our viewing audience, thank you for joining us for this Targeted OncologyVirtual Tumor Board®. We hope so much that today’s discussion was valuable and that you acquired some practical knowledge that can help you care for your patients wherever you’re practicing.

Transcript edited for clarity.

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