RCC at ASCO 2019: Immunotherapy for Sarcomatoid Disease

Sumanta Kumar Pal | July 29, 2019

I still remember the debates around treating sarcomatoid renal cell carcinoma (RCC) a decade ago when I started in practice. There were not many studies to cite – one that often came up was Naomi Haas’s trial of doxorubicin with gemcitabine (ECOG 8802). The study showed progression-free survival (PFS) of 3.5 months and overall survival (OS) of 8.8 months – sobering results, but at least an option we could pursue in the clinic. I only treated a handful of patients with this regimen, but it was certainly no walk in the park – massive fatigue, cytopenias and a range of other toxicities.

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Sumanta Kumar Pal, MD

Sumanta (Monty) Kumar Pal, MD, is an internationally recognized leader in the area of genitourinary cancers, including kidney, bladder, and prostate cancer. He is the Co-director of City of Hope's Kidney Cancer Program and is the head of the kidney and bladder cancer disease. Dr. Pal sits on the Editorial Board for clinical genitourinary cancer and is a reviewer for multiple journals including The Journal of Clinical Oncology, The Journal of Urology, European Urology, and many others.

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Everyday Urology - Oncology Insights
Publications focusing on urologic cancer treatments through original manuscripts
By Anil Kapoor, MD
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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Evidence based monographs by experts to define and guide clinical practice
Written by Jason Zhu, MD
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
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
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
Written by Christopher J.D. Wallis, MD, PhD
Kidney cancer is a broad, encompassing term that borders on colloquial. While most physicians are referring to renal cell carcinoma when they say “kidney cancer”, a number of other benign and malignant lesions may similarly manifest as a renal mass. Considering only the malignant causes, kidney cancers may include renal cell carcinoma,
Expert Commentary
Evidence based monographs by experts to define and guide clinical practice
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
Recent data from conferences worldwide
Presented by Neeraj Agarwal, MD
Barcelona, Spain (UroToday.com) Androgen deprivation therapy (ADT) has long been considered the standard of care for patients with metastatic prostate cancer, however recent studies have shown improved survival outcomes by adding additional agents.
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 Chung-Han Lee, MD, PhD
Barcelona, Spain (UroToday.com) Altered glucose and glutamine metabolism is a hallmark of renal cell carcinoma (RCC). Abnormal glucose metabolism, known as the Warburg effect, deprives the citric acid cycle (TCA cycle) of critical metabolites.
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 Daniel Yick Chin Heng, MD, MPH
San Francisco, CA (UroToday.com) Dr. Heng's presentation focused on second- and third-line therapies for metastatic renal cell carcinoma. In order, to decide which 2nd line therapy patients should receive, there are several determinants.
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 
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