Robert J. Motzer, MD:From his initial presentation, he originally presented with abdominal pain, which was found to be related to the diverticulitis. The metastatic kidney cancer was an incidental finding, which is now the most common way that kidney cancer is diagnosed. About 60% of patients at our center present with kidney cancer as an incidental finding.
One of the other features of this patient is the fact that in initial presentation he had a locally advanced disease, and with subsequent metastasis or relapse, within a year to 2 years. One of the problems, or the difficulties and challenges with this disease, is that there aren’t early warning signs for kidney cancer. So, about 25% of people will present with over metastasis at diagnosis, and another 30% of patients with localized disease will subsequently relapse. As a result, there’s a relatively large proportion of people diagnosed with kidney cancer that will ultimately need systemic therapy.
Good pathologic examination by pathologists is essential to type the kind of kidney cancer, to make sure it’s clear cell carcinoma. But beyond the morphology and the grade, there really isn’t any kind of standard biologic studies or biomarkers that are obtained on the kidney tumor that help us define treatment. There has been a high interest in studies for PD-L1 expression in kidney tumors, but for the most part they don’t exclude benefit with checkpoint inhibitors, and so they’re not used in standard management.
Transcript edited for clarity.
A Japanese-American Male With Recurrent RCC