Peter Clark, MD, professor of medicine and chair of urology, Levine Cancer Institute, Atrium Health, discusses the need for biomarkers in renal cell carcinoma (RCC).

Cytoreductive nephrectomy is a traditional surgical approach used for patients with RCC, but with the rise of systemic therapy using TKIs, the role of this procedure has become unclear. Researchers hoped the phase III CARMENA trial, which tested surgery combined with sunitinib (Sutent) versus sunitinib alone, would refine this paradigm, but unfortunately, it did not.

Clark adds that having an effective biomarker would be extremely helpful in this paradigm, as it can be used to better identify which systemic therapy should be used for these patients. Currently, clinicians use clinical factors to determine which patients have rapidly progressive disease and would not benefit from surgery, and which patients have indolent disease and could have their cancer resected. Oftentimes, oncologists are creating a treatment strategy right at the time of diagnosis, but they don’t have a natural disease history in which to base their plan.

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Peter Clark, MD, professor of medicine and chair of urology, Levine Cancer Institute, Atrium Health, discusses the need for biomarkers in renal cell carcinoma.

Dr. Clark Discusses Need for Biomarkers in RCC

Peter Clark, MD, medical oncologist, Levine Cancer Institute, Atrium Health, discusses the role of cytoreductive nephrectomy in the treatment of patients with renal cell carcinoma (RCC).

The use of cytoreductive nephrectomy has long been debated—increasingly so since the advent of TKIs. The CARMENA trial tested the value of cytoreductive nephrectomy plus adjuvant sunitinib (Sutent) compared with sunitinib alone in patients with metastatic RCC. The trial showed that there was no difference between a nephrectomy and adjuvant sunitinib versus single-agent sunitinib.

The TKI showed median overall survival (OS) rates of 23.4 months and 19.0 months in intermediate-risk patients with sunitinib monotherapy and nephrectomy followed by sunitinib, respectively (HR, 0.92; 95% CI, 0.68-1.24). Median OS rates in poor-risk patients were 13.3 months and 10.2 months, respectively (HR, 0.85; 95% CI, 0.62-1.17). Now, physicians are navigating surgery’s application by way of careful patient selection. The procedure should not be used freely and should not be used in the highest-risk patients. It should also be avoided in patients who have unresectable disease, concludes Clark.

Dr. Clark on the Role of Cytoreductive Nephrectomy in RCC

Peter Clark, MD, medical oncologist, Levine Cancer Institute, discusses the potential of immunotherapy in the treatment of patients with renal cell carcinoma (RCC).

Checkpoint inhibition holds a lot of promise in the treatment landscape of RCC, says Clark. That class of therapy, notes Clark, ramps up a patient’s immune system and releases the brakes that were put in place to inhibit the immune system’s ability to fight the cancer. Though it is not effective for every patient with RCC, it has shown tremendous activity in those in which it works.

Checkpoint inhibition has also made a big impact on the treatment landscape of advanced bladder cancer, says Clark. Ongoing trials are looking at the optimal space in which to place these therapies. Clinical trials are looking at patients with metastatic disease, locally advanced disease, and even earlier-stage disease. Immunotherapy has likely been the biggest development in bladder cancer, concludes Clark.

Peter Clark, MD

Articles

Dr. Clark Discusses Need for Biomarkers in RCC

Dr. Clark on the Role of Cytoreductive Nephrectomy in RCC

Dr. Clark on the Potential of Immunotherapy in Renal Cell Carcinoma