Neoadjuvant Therapy for Renal Cell Carcinoma: Insights from Experts

Core Concepts

Neoadjuvant therapy in renal cell carcinoma shows promising results in downsizing tumors and improving surgical outcomes.

Abstract

• Introduction to the podcast series on RCC by Dr. Monty Pal and Dr. Jose Karam.
• Dr. Karam's journey into kidney cancer research and his work on neoadjuvant therapy.
• Overview of the neoadjuvant axitinib trial for clear cell kidney cancer.
• Comparison of various neoadjuvant trials with TKIs like pazopanib and sunitinib.
• Discussion on the effectiveness of immunotherapy alone and in combination with neoadjuvant therapy.
• Results from a study combining axitinib with avelumab in the neoadjuvant setting.
• Considerations for using neoadjuvant therapy in RCC patients.
• Importance of mentorship and training in the field of kidney cancer research.

Stats

"We ultimately ended up enrolling 24 patients with clear cell kidney cancer, all biopsy proven, all locally advanced disease, and gave them axitinib for a total of 12 weeks."
"Most of the patients, 23 of them, were able to continue therapy for 11-12 weeks, which is what we wanted."
"We had, I believe, 11 out of 24 patients with a partial response — about 46% of patients who had a partial response by the response evaluation criteria in solid tumors (RECIST) criteria."

Quotes

"The higher you can go on the dose of the axitinib, you'll probably see better responses."
"If we need to see primary responses, either TKIs alone or TKIs with immunotherapy would be the way to go."
"Neoadjuvant therapy is not standard of care and should not be routinely given by any urologist or medical oncologist."

Key Insights Distilled From

S2 Episode 6: Neoadjuvant Therapy and Renal Cell Carcinoma

by Sumanta Pal at www.medscape.com 09-07-2023

https://www.medscape.com/viewarticle/984249

Deeper Inquiries

What are the challenges in translating neoadjuvant therapy into standard care for RCC patients?

One of the primary challenges in translating neoadjuvant therapy into standard care for RCC patients is the lack of robust clinical evidence supporting its widespread adoption. While there have been promising results from studies on neoadjuvant therapies such as TKIs and IO agents, the data is still limited, and more research is needed to establish the efficacy and safety of these approaches. Additionally, the variability in patient responses to neoadjuvant treatments poses a challenge in determining the optimal candidates who would benefit the most from such therapies. Moreover, the complexity of RCC, with its diverse subtypes and disease presentations, adds another layer of challenge in developing standardized neoadjuvant treatment protocols that can be universally applicable to all patients.

How can the field of kidney cancer research benefit from more collaborative studies on neoadjuvant therapies?

Collaborative studies on neoadjuvant therapies in kidney cancer research can bring about several benefits to the field. Firstly, by pooling resources, expertise, and patient populations from multiple institutions, collaborative studies can enhance the statistical power and generalizability of the findings, leading to more robust and reliable results. Additionally, collaborative efforts allow for the exploration of different treatment modalities, combinations, and dosages, which can help identify the most effective neoadjuvant regimens for RCC patients. Furthermore, sharing data and insights across research teams can accelerate the pace of discovery, facilitate the validation of findings, and ultimately expedite the translation of research outcomes into clinical practice. Overall, collaborative studies foster a synergistic environment that promotes innovation, knowledge exchange, and advancements in the field of kidney cancer research.

How does the role of neoadjuvant therapy in RCC impact the overall treatment landscape for kidney cancer patients?

The role of neoadjuvant therapy in RCC has a significant impact on the overall treatment landscape for kidney cancer patients by introducing a paradigm shift in the management of the disease. Neoadjuvant therapy offers the potential to downsize tumors, increase resectability, and improve surgical outcomes for patients with locally advanced or aggressive RCC. By administering systemic treatments before surgery, neoadjuvant therapy can target the primary tumor and metastases, potentially reducing the extent of surgical intervention required and improving the chances of complete tumor removal. This approach not only provides valuable insights into the tumor biology and treatment response but also opens up new avenues for personalized treatment strategies based on individual patient characteristics. Furthermore, neoadjuvant therapy may pave the way for innovative combination therapies, such as TKIs with IO agents, that could enhance treatment efficacy and long-term outcomes for kidney cancer patients. Overall, the incorporation of neoadjuvant therapy into the treatment landscape for RCC represents a promising avenue for optimizing patient care, refining treatment protocols, and advancing the field of kidney cancer research.