Overview of Advanced Renal Cell Carcinoma


An overview of advanced Renal Cell Carcinoma (aRCC), including its prevalence, patient presentation, classification, and treatment criteria.

Dr. Robert Motzer: Hello, and thank you for joining this Targeted Oncology discussion entitled Updates in the Treatment of Advanced Renal Cell Carcinoma. Joining me today are my esteemed colleagues, Dr. Plimack and Dr. Rini. Whoops, something just happened to my lovely stage here. Hold on for a minute. I'm going to do that again. Something just happened to my-. Hello, and thank you for joining this Target Oncology discussion entitled Updates in the Treatment of Advanced Renal Cell Carcinoma. Joining me today are my esteemed colleagues, Dr. Plimack and Dr. Rini. I would like to invite you both to introduce yourselves.

Dr. Elizabeth Plimack: Thanks, Bob. Hi, I'm Betsy Plimack. I'm a GU medical oncologist at Fox Chase Cancer Center in Philadelphia.

Dr. Brian Rini: Pleasure to be here. I'm Brian Rini. I'm a GU medical oncologist and chief of clinical trials at Vanderbilt-Ingram Cancer Center in Nashville.

Dr. Robert Motzer: Thank you so much for joining me. In today's precision medical and oncology discussion we will talk about recent treatment updates in patients with advanced renal cell carcinoma and how these data could impact both the treatment landscape and the clinical practice. Let's begin. So this was a very exciting ASCO meeting that we all just attended. And I think that there were important presentations with regard to the phase three trial with IO TKI checkpoint inhibitor combinations. So with regard to just a brief overview of advanced RCC, renal cell cancer is not a rare cancer, afflicts about 70,000 patients each year. Patients generally present either with a kidney primary in place with hematuria or as an incidental finding. And then at staging, about 25% of patients will have evidence of metastasis. The primary management is a nephrectomy, but based on the high number of patients with metastasis at diagnosis or the fairly high frequency of patients who relapse, many of patients will require systemic therapy. There's various ways of classifying RCC, of course by histology. The predominant type is called clear cell carcinoma. And then there's a group of what's referred to as non-clear cell RCC, that's a heterogeneous group of mixed histologies. There's various systems that have been developed to help guide prognosis for patients, particularly with the clear cell. And the most recent one is the IMDC, which is made up of six different risk factors for a short survival. These risk factors include hypercalcemia, high platelet count, high white blood count, anemia, a short time from diagnosis to start of treatment, less than a year, and a performance status of 70 or less. And patients are grouped together into three categories. Those with favorable risk, who have zero of these risk factors. The intermediate risk group that have one or two, and then the poor risk group that has three or more of these risk factors. For the most part, most patients generally do receive a nephrectomy whether or not they have metastatic disease or not. Initially if it's localized and for patients with metastatic disease, the cytoreductive nephrectomy had previously done almost exclusively before treatment, but now there is an option for delayed cytoreductive nephrectomy in suitable candidates as well.

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