SIU 2017: New Therapy for Advanced RCC

Lisbon, Portugal ( In this three part series, the speakers help guide us through the advances in RCC management. Dr. Linehan finished the series by speaking about the treatment of advanced RCC, specifically the barriers and new opportunities.

His talk focused more on major principles, including the personalization of therapies, rather than specifics. As such, the summary below highlights his main take-home points and messages.

At this point in time, we are up 17 different renal cell carcinoma subtypes! And this will likely continue to expand.

Additionally, there are new opportunities in the field that need further exploration. While targeted therapies have been approved for over 10 years now, the introduction of the immune checkpoint inhibitors has reinvigorated the field. Having been present for the initial experience with immune therapy (IFN-alpha, IL-2), he feels the current immune checkpoint inhibitors have a lot of promise. He did mention to pay attention to the development of CAR-T (chimeric antigen reception therapy), which has yet to demonstrate success in solid malignancies – but when it does, may again drastically change the landscape of opportunities. Lastly, the promise of combination therapies – immune checkpoint therapies with each other, with targeted therapies and even with other agents – may yield greater results than any monotherapy.

He focused the rest of his talk on three main histologies of RCC to highlight some of the progress made. He focused on clear cell RCC, papillary type I RCC, and papillary type II RCC. While much of the discussion was on anecdotal evidence or discussion of molecular pathways, there was some important take-home messages:
1) Intratumoral heterogeneity has become critically important – RCC is understood to have significant heterogeneity even within the primary lesion. Better characterization of the primary tumor and metastases can help guide more targeted therapy.

He feels there will be significant advancements in the stratification and management of patients with RCC in the next few years. However, international collaboration amongst centers of excellence is the key to success.

Speaker: W. Marston Linehan, NIH

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal
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