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ASCO GU 2019 Kidney Cancer

ASCO GU 2019: A Phase II Study CALYPSO: The Safety and Efficacy of Savolitinib and Durvalumab in Metastatic Papillary Renal Cancer

San Francisco, CA (UroToday.com) The most common non-clear cell renal cell carcinoma is papillary renal cell carcinoma (pRCC). pRCC accounts for 15-20% of RCC and are subcategorized into Type 1 and Type 2. Type 1 pRCC are typically associated with MET alterations whereas Type 2 pRCC typically are found to have alterations in SETD2, TFE3, and CDKN2A1.

ASCO GU 2019: Outcomes of Patients with Metastatic Clear Cell RCC Treated with Second Line VEGFR-TKI After First Line Immune Checkpoint Inhibitor

San Francisco, CA (UroToday.com) Since the publication of CheckMate 214, immune checkpoint inhibitors (ICIs) have entered the first line space for the treatment of metastatic RCC1. However, the majority of patients do not have an objective response to ICI and will have either primary or secondary resistance. Standard of care second line therapies involves VEGFR-TKIs, but little is known about their efficacy after ICI treatment.  This study seeks to address this knowledge gap by providing a multicenter experience of treatment of mRCC after ICI therapy.

ASCO GU 2019: Questions and Lessons Moving Forward from CARMENA: Which Treatment First? Surgeon’s Perspective

San Francisco, CA (UroToday.com) Dr. Russo gave the surgeon’s perspective of cytoreductive nephrectomy.  The role and rationale for cytoreductive nephrectomy (CN) is multi-fold:

  • Remove a large, potentially immunosuppressive tumor that is a potential source of metastases and paraneoplastic syndromes
  • Palliate local symptoms of pain or bleeding that could complicate/interrupt systemic therapy
  • Obtain accurate pathologic subtyping to guide therapy
  • Should never be done to induce spontaneous metastatic tumor regression (it is a real event, but rare)

ASCO GU 2019: Questions and Lessons Moving Forward from CARMENA: Which Treatment First? Medical Oncologist’s Perspective

San Francisco, CA (UroToday.com) Dr. Harshman gave the Medical Oncologist perspective of cytoreductive nephrectomy (CN) . As has been the case for many of these debates recently, there wasn’t much of a debate – both medical oncologists and urologists have been on the same page!

ASCO GU 2019: Informing the Decision Using Data Science

San Francisco, CA (UroToday.com) In this first talk of the point-counterpoint session, Dr. Psutka reviews the literature informing the decision to expand the use of partial nephrectomy to larger, more complex masses, effectively titled “extended partial nephrectomy” (ePN).

To begin, the only Level 1 evidence supporting the oncologic efficacy PN compared to RN is the EORTC study by van Poppel et al. (EU 2007). However, it was underpowered and had significant cross-over. 

ASCO GU 2019: Quality Metrics in Kidney Cancer Care

San Francisco, CA (UroToday.com) The last session of GU ASCO 2019, How Can We Better Treat Kidney Cancer, started with Dr. John Gore presented quality metrics in kidney cancer care. Dr. Gore notes that quality measurement entails several processes, including effectiveness, efficacy, equity, patient-centeredness, safety, and timeliness. Dr. Gore then mentioned that health care value is disparate in the United States, considering that the country has the highest per-capita spending per person for health care ($9,892), but is 27th in life expectancy (78.8 years). By comparison, Japan is 15th in spending ($4,519) and 1st in life expectancy (83.9 years).

ASCO GU 2019: Outcomes for Avelumab Plus Axitinib versus Sunitinib in Advanced RCC - JAVELIN Renal 101: A Subgroup Analysis

San Francisco, CA (UroToday.com) The first line treatment for mRCC disease space is rapidly changing, including the first reporting of JAVELIN Renal 101 at ESMO 2018 comparing avelumab plus axitinib versus sunitinib. Highlights of this first analysis included a longer progression-free survival (PFS) (median, 13.8 vs 8.4 months; HR 0.69; p=0.0001) and better objective response rate (ORR) (51% vs 26%) for combination avelumab plus axitinib versus sunitinib in patients with previously untreated advanced/metastatic RCC.
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