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Advanced Kidney Cancer

Curated by clinicians: educational forums with videos, abstracts and conference information
Rana R. McKay, MD

Rana R. McKay, MD is an Associate Professor of Medicine and Urology at the University of California San Diego and Co-Leader of the Genitourinary Oncology Disease Team at the Moores Cancer Center. She is a board-certified medical oncologist who specializes in treating people with urogenital cancers, including bladder, kidney, prostate, and testicular cancer. Her research interests include the design and implementation of clinical trials to advance the treatment of patients with urologic cancers. She serves as the Principal Investigator of several early phase trials in kidney and prostate cancer. As a clinical investigator, she is committed to advancements that will improve the lives of individuals with cancer. Furthermore, she is interested in understanding mechanisms of response and resistance to specific cancer therapies. Her work has appeared in peer-reviewed publications such as the Nature, Lancet, Journal of Clinical Oncology, Clinical Cancer Research, Cancer, among others. Dr. McKay earned her medical degree at the University of Florida College of Medicine before completing her residency in Internal Medicine at Johns Hopkins Hospital. She completed a fellowship in Oncology/Hematology at the Dana-Farber Cancer Institute, Harvard Medical School. She went on to serve as an Assistant Professor at Harvard Medical School and a medical oncologist at Dana-Farber/Brigham and Women's Cancer Center in Boston before joining UC San Diego Health.

Videos
Clinical Conversations by Experts
Everyday Urology - Oncology Insights
Publications focusing on urologic cancer treatments through original manuscripts
By Christopher Wallis
Published January 2021

When examined at a national level in the United States, cancers of the kidney and renal pelvis (despite different histology) are considered in aggregate and represent the sixth most common newly diagnosed tumors in men and eighth most common in women in the United States in 2020,1 representing an estimated 73,750 new diagnoses and 14,830 deaths. The vast majority of these cancers will be renal parenchymal tumors with renal cell carcinoma (RCC) comprising the preponderance of these lesions.
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By Anil Kapoor, MD
Published Date: March 2018

Urologists are primed to acquire the knowledge to use targeted agents and immuno-oncologic (IO) therapies for the treatment of advanced and metastatic renal cell carcinoma (RCC). Toxicities are manageable given appropriate patient/caregiver education, on-call, and nursing support, and multi-disciplinary care with consulting specialists. 
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Library Resources
The State-of-the-Evidence in Brief Reviews by Experts
Written by Christopher J.D. Wallis, MD, PhD, and Zachary Klaassen, MD, MSc
March 31, 2021
Cancers of the kidney and renal pelvis (when considered in aggregate despite different histology) represent the 6th most common newly diagnosed tumors in men and 8th most common in women in the United States in 20201, representing an estimated 73,750 new diagnoses and 14,830 deaths.
Written by Jason Zhu, MD
January 29, 2019
Kidney cancer represents 5% of all new cancer diagnoses in the United States, with approximately 64,000 new cases and 14,970 deaths in 2018.1,2 The most common type of kidney cancer is renal cell carcinoma (RCC) and the most common histologic subtype of RCC is clear cell RCC, accounting for over 80% of cases.3
Written by Christopher J.D. Wallis, MD, PhD
January 21, 2019
As highlighted in prior articles on the Etiology and Epidemiology of Kidney Cancer, cancers of the kidney and renal pelvis comprise the 6th most common newly diagnosed tumors in men and 10th most common in women1 and account for an estimated 65,340 people new diagnoses and 14,970 cancer-related deaths in 2018 in the United States.
Written by Jason Zhu, MD
November 29, 2018
Kidney cancer is the 12th most common cancer in the world, with over 300,000 new cases annually, of which 65,340 new cases will be diagnosed in the United States in 2018.1 The incidence of renal cell carcinoma (RCC) varies substantially based on the country – rates of RCC are higher in Europe and North America and much lower in Asia and South America.2
Expert Commentary
The State-of-the-Evidence in Brief Reviews by Experts
Written by Zhamshid Okhunov, MD
Department of Urology, University of California, Irvine Urology
Though nephrectomy is the gold standard treatment for renal cell carcinoma, 20%-40% of patients have a recurrence and 20-30% of patients present with metastatic disease1.
Written by Zhamshid Okhunov, MD
Department of Urology, University of California, Irvine Urology
Partial nephrectomies are the standard of care with treatment of T1a or T1b tumors due to their better functional outcomes and decrease cardiovascular morbidity.
Written by Zhamshid Okhunov, MD
Department of Urology, University of California, Irvine Urology
Laparoscopic renal surgery (LRS) has long been recognized for its improvements over open renal surgery for patient quality of life.
Conference Coverage
Conference Highlights from Recent Conference Coverage
Presented by David F. McDermott, MD
The European International Kidney Cancer Symposium 2021 virtual meeting’s keynote lecture was provided by Dr. David McDermott discussing kidney cancer as a model for a curable neoplasm. 
Presented by Yann-Alexandre Vano, MD
Dr. Vano discussed biomarker-driven trials. He first argued for the rationale of biomarker-driven trials based on the rationale that metastatic kidney cancer represents an incurable disease and current therapies have significant toxicity. He further emphasized that, based on drug development over the past two decades, there are many treatment options in mRCC that improve survival.
Presented by Thomas Powles, MBBS, MRCP, MD
The European International Kidney Cancer Symposium 2021 Virtual Meeting included a systemic therapy session and a presentation by Dr. Thomas Powles discussing tissue-based biomarkers for potential clinical adoption in renal cancer.
Presented by Camillo Porta, MD
To help guide treatment choices for those who progress on first-line therapy, Dr. Camillo Porta discussed modern therapeutic approaches in second-line and later therapies in a presentation at the European International Kidney Cancer 2021 Virtual Annual Meeting.
Presented by Stephanie A. Berg, DO
Following presentations by Dr. Robert Motzer discussing results of the CLEAR study of lenvatinib plus pembrolizumab or everolimus versus sunitinib in first-line treatment of advanced renal cell carcinoma and by Dr. Sumanta Pal looking at the SWOG 1500 trial of sunitinib, cabozantinib, crizotinib, and savolitinib in patients with metastatic papillary renal cell carcinoma.
Presented by Brian I. Rini, MD
The activity of tivozanib after axitinib has not been previously defined, and as such the activity of tivozanib after prior therapy types including axitinib is of clinical relevance. At the 2021 ASCO GU, Dr. Brian Rini and colleagues presented results of the TIVO-3 trial testing tivozanib in patients with advanced RCC who had progressed after prior axitinib treatment.
Presented by David Cella, PhD
The treatment landscape for first-line therapy among patients with metastatic renal cell carcinoma (mRCC) has changed dramatically over the past 2 years. In 2018, publication of the CheckMate214 data demonstrated a survival benefit for patients treated with nivolumab and ipilimumab compared with sunitinib in intermediate and poor-risk mRCC, ushering in the immunotherapy era for mRCC.
Presented by Andrea B. Apolo, MD
Cabozantinib, nivolumab, and ipilimumab have been increasingly utilized for a number of genitourinary malignancies, most prominently in renal cell carcinoma. In a dose-escalation study, combinations of cabozantinib and nivolumab (CaboNivo) and cabozantinib, nivolumab, and ipilimumab (CaboNivoIpi) demonstrated promising efficacy and safety in a dose-escalation phase I study.
Presented by Toni Choueiri, MD, MS
In this state-of-the-art presentation, Dr. Toni Choueiri gave an overview of the management of advanced kidney cancer. Several years ago, before the era of immunotherapy, when vascular endothelial growth factor (VEGF) receptor inhibitors were compared and used to treated advanced kidney cancer patients, the median overall survival was only 13 months.
Presented by Yann-Alexandre Vano, MD, PhD
Sunitinib was standard first line treatment for metastatic clear cell renal cell carcinoma (mccRCC) for many years until multiple clinical trials showed superior efficacy of various treatment combinations including nivolumab and ipilimumab in International Metastatic RCC Database Consortium (IMDC) intermediate or poor-risk disease.
Presented by Tim Q. Eisen, PhD, MB, BChir
Barcelona, Spain (UroToday.com) Four large, randomized Phase 3 clinical trials (S-TRAC, ASSURE, PROTECT, and ATLAS) evaluated adjuvant VEGF tyrosine kinase inhibitors in patients with resected renal cell carcinoma (RCC).
Presented by Axel Bex, MD, PhD
Barcelona, Spain (UroToday.com) The current standard for advanced localized renal cell carcinoma (RCC) is nephrectomy. Unfortunately, for better or worse, the series of adjuvant therapy
Presented by Marc-Oliver Grimm
Barcelona, Spain (UroToday.com) Dr. Marc-Oliver Grimm provided an overview of the many changes in the landscape for advanced renal cell carcinoma at the urogenital cancer treatment at a glance session. He started by highlight that the guidelines for advanced kidney cancer have been revamped recently
Presented by Cristina Suarez, MD
Munich, Germany (UroToday.com) IMmotion 150 (Phase II) compared the efficacy of atezolizumab (atezo) plus bevacizumab (bev) with atezolizumab alone and sunitinib alone