The International Kidney Cancer Symposium (IKCS) 2021 took place in North America over the weekend. The following presentations are of interest to kidney cancer patients and their families and are published by UroToday:
Award lecture: Dr Brian Lane gave the Andrew C. Novick Award Lecture with a talk focusing on the management of small (T1) renal masses. Dr Lane began by highlighting the value of his training at the Cleveland Clinic, quoting Charles Dickens to say, “it was the best of times, it was the worst of times”. He concluded by emphasising that trust is earned. Patients should demand and deserve both competence and compassion. While urologists typically focus on treatment to cure the patient, medical oncologists and other disciplines consider a more holistic approach, including palliative care, symptom control and disease management.
Impact of adjuvant immunotherapy on first line treatment: Dr Toni Choueiri focused on the role and effects of adjuvant immunotherapy for renal cell carcinoma (RCC) on subsequent first-line therapy. He provided an overview of his perspective of the future of adjuvant therapy for RCC.
Non-clear cell RCC; Characterisation of renal masses using a ‘virtual’ biopsy. Dr Ivan Pedrosa discussed the genetic characterisation of kidney masses using a ‘virtual’ biopsy. Virtual biopsy with a clear cell likelihood score on MRI can assist in the management of small renal masses by reducing the need for biopsy and surgery for benign tumours.
Surgical management of non-clear cell RCC. Dr Ronald Boris discussed surgery for non-clear cell RCC. Dr Boris notes that histology matters in the behaviour of both localised and metastatic RCC. Understanding the subtype of the kidney tumour and specific behaviours associated with the subtype can influence the type of surgery for both localised and metastatic RCC.
Systemic therapy for non-clear cell RCC: Recent and future studies. Dr Bradley McGregor discussed recent and future studies of systemic therapy for non-clear cell RCC, highlighting that non-clear cell RCC has worse outcomes than clear cell RCC. There have been multiple advances for the treatment of non-clear cell RCC subtypes, including VEGF inhibitors, chemotherapy, and combination regimens (ie. immunotherapy, VEGF, mTOR). Treatment directed at the histology of the tumour is the ultimate goal.
Enhancing patient-centred care in systemic therapy and clinical trials. Dr Biren Sariaya presented on how patient-centred care may be improved. Dr Sariaya suggested that shared decision-making is the key to ensuring that patient values guide all clinical decisions. This process of shared decision-making can help patients evaluate options in the context of what is important to them.
The role of inferior venous cava (IVC) thrombus with stereotactic body radiotherapy (SBRT) – Neoadjuvant SBRT. Dr Raquibul Hannan discussed the role of neoadjuvant stereotactic body radiotherapy (SBRT) in patients with RCC and IVC tumour thrombus. The only potentially curative treatment for patients with an IVC thrombus is surgery, which is associated with a 35% rate of morbidity and 5-13% rate of mortality. However, there is an increased risk of relapse and metastasis even after surgery to remove the IVC thrombus.