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Some very interesting work has been coming out of the Francis Crick Institute in London about the evolution of kidney tumours. The research is being led by Dr Samra Turajlic who also works at the Royal Marsden Hospital in London and is one of KCSN’s trustees. Here is her explanation of this very exciting work:
All the work was done in with clear cell renal cell carcinoma (RCC) tumours, but these revolutionary subtypes relate well to clinical behaviour and patient outcomes.
Tumours that evolve very slowly and have limited genetic changes correspond to small renal masses, which we know can be observed for long periods of time without any evidence of progression.
There are other tumours that also grow slowly; however, these tumours develop different genetic changes in different areas of the tumour over time (this is similar to the evolution of different species in nature). These tumours are genetically mixed and gradually acquire the ability to spread (metastasise) and form metastases that can sometimes be treated with surgery. We also observe that these patients can benefit from cytoreductive nephrectomy (i.e., when the primary tumour is removed after tumour spread has already happened).
Finally, some tumours acquire lots of genetic changes in a short time window and are dominated by a very aggressive population of cells. We observe that these tumours become metastatic very early and patients with these primary tumours develop rapid and widespread metastases.
The information we used in this research study to derive the evolutionary classification is not currently obtained in the course of routine clinical care, because at present genetic profiling does not play a role in the management of patients with kidney cancer.
Our next challenge is to try and implement this in practice in a way that is tractable and useful. We also need to understand how the evolutionary subtypes respond to different therapies currently used in clinic and whether we can use them to predict the patients that will benefit from particular drugs. This work is underway in the TRACERx Renal programme.
