A panel of expert genitourinary oncologists give an overview of renal cell carcinoma and present the case of a 61-year-old man with metastatic clear cell RCC.
Elizabeth Wulff-Burchfield, MD: Hello, and welcome to this Targeted Oncology™ Virtual Tumor Board®. I am Elizabeth Wulff-Burchfield, and I’m joined by my expert colleagues, Dr Rana McKay, Dr Pedro Barata, and Dr Bradley McGregor. This tumor board is going to focus on the management of clear cell renal cell carcinoma [RCC]. In today’s presentation, my colleagues and I will review 2 clinical cases. We’ll discuss approaches to treating patients with renal cell carcinoma and share our perspectives on key clinical trial data that can impact our decisions. As I said, I’m Elizabeth Wulff-Burchfield. I’m an assistant professor of medicine in the division of medical oncology at the University of Kansas Health System in Kansas City. I’m joined by a panel of true experts that we are so lucky to have. I’d love to invite them to introduce themselves. Why don’t we start with Dr McKay?
Rana McKay, MD: Thank you so much for having us today. I’m Rana McKay. I’m a GU [genitourinary] medical oncologist at the University of California in San Diego. It’s a real pleasure to be here with my amazing colleagues.
Elizabeth Wulff-Burchfield, MD: Thank you so much. Dr Barata?
Pedro Barata, MD: Great, I’m also very excited to be here. I’m Pedro Barata, a GU oncologist here at Seidman Cancer Center, at Case Western [Reserve University] in Cleveland, Ohio. I’m happy to join for these 2 cases and tumor board discussion. Thank you for having me.
Elizabeth Wulff-Burchfield, MD: Thank you. Last but not least, Dr McGregor?
Bradley McGregor, MD: I’m Brad McGregor. I’m also a GU medical oncologist at Dana-Farber Cancer Institute in Boston [Massachusetts] and happy to be here with everyone talking about these cases today.
Elizabeth Wulff-Burchfield, MD: We have such great representation across the country today. Why don’t we get started? For our first case presentation, Dr Barata, I think you were going to read that for us.
Pedro Barata, MD: Sure. We have a 61-year-old man with a history of low volume indolent metastatic clear cell RCC. His status was left nephrectomy and adrenalectomy. Of note, he’s a married father of 2 grown children, and has 5 grandchildren, so a very good social support system with family living nearby. Has an active lifestyle. He [walks] 10,000 steps a day and golfs regularly.
He has been under observation for this low volume indolent disease based on his preference and his treating physician’s preference as well. Things have been moving slowly, and about 3 years after his nephrectomy you continue to appreciate an indolent growth in scans. At this point, you have an increased total tumor burden. You identify a new paratracheal lymph node with a 2-cm or larger axis, and several lung nodules, both sites seen on CT scans. You end up biopsying one of those lung lesions and confirm them to be metastatic clear cell RCC with a good performance status. There are no changes in laboratory test results. [That is] the case we have for discussion today.
Elizabeth Wulff-Burchfield, MD: Thank you. In thinking about this patient, the work-up and staging for renal cell carcinoma is pretty standard. Given the participants who will be watching this session, I don’t think they need any advice from us about that. But one questions that’s so different with RCC compared to a lot of other solid tumors is how we think about NGS [next-generation sequencing] testing, molecular testing, and how we use that in our decision-making or not. I know there’s always a lively discussion about this at our meetings, I’d love for one you to give me some insights. Dr McKay, would be willing to share your practices? Is this something you order up front? What is it looking like?
Rana McKay, MD: I think with the widespread availability and coverage for these molecular tests, we are using them more frequently. At the present time, they don’t necessarily inform direct treatment decisions, but for somebody who has metastatic disease, especially if they’re nonclear cell, I do like to get it done up front. I like to know if there are any potential targetable alterations, not necessarily for what I’m going to do right now, but potentially down the road that could, if we get to the third or fourth line, inform therapy. Do they have a TSC alteration or other alterations in that vein? What’s their VHL status? A lot of times when patients can’t really be classified, I like to see if they have a VHL alteration; are they going behave more like a clear cell when they do versus not?
It is something that I think we talk about doing up front because it can take time for the test results to come back. The information can also be prognostic, and I think sometimes that could be helpful. But as part of standard of care, it’s absolutely not required in any way, shape, or form for treatment decision-making or risk stratification at the present time.
Elizabeth Wulff-Burchfield, MD: Thank you so much. I think that’s great insight, especially hearing how you use it for your unclassified patients, or nonclear cell, but particularly those who are unclassified.
Transcript edited for clarity.