In this session, Dr. Arie S. Belldegrun, UCLA presented an update on renal cell cancers. He reviewed that 30-40% of patients present with metastatic disease and 30-40% develop metastasis after nephrectomy. Prognostic nomograms are critical for risk-group assessment and patient selection for clinical trials, argued Dr. Belldegrun. Long-term data shows that surgery and immunotherapy does not improve overall survival. However, molecular approaches will improve the detection and treatment of RCC. For example, 14 Phase II and III clinical trials are presently ongoing or recently completed.

He showed the UCLA data that nephrectomy plus IL-2 immunotherapy was superior to nephrectomy alone or surgery combined with INF- . Patients identified by risk stratification nomograms selected patients who might benefit from therapy as compared to those whose prognosis was too dismal too benefit with present therapies. Adjuvant therapies however have resulted in a shift in the risk curves so that intermediate-risk patients now look more like low-risk patients. Using molecular markers such as CAIX, patients were identified who performed better with immunotherapy.

Dr. Belldegrun stated that stable disease could lead to improved progression free survival. He also suggested that large tumors should undergo debulking nephrectomy prior to targeted therapy, like the immunotherapy with neoadjuvant surgery approach. He emphasized that patient selection is the key to success.

Dr. Belldegrun pointed out that ongoing questions include finding more molecular markers for patient selection, surrogate markers to follow patients and the role for neoadjuvant-targeted treatments.

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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