Dr Croll on the Development of Biomarkers in RCC

“[The development of biomarkers in RCC] is the holy grail, and you hear it talked about at so many meetings, because we’ve had success in other [malignancies like] prostate cancer, with using genomic markers in order to predict response.”

Benjamin Croll, MD, a urologic oncology fellow at Fox Chase Cancer Center, discussed the importance of developing effective biomarkers in renal cell carcinoma (RCC).

One of the most important goals in RCC is the development of biomarkers capable of predicting both prognosis and response to therapy, Croll began. Investigators frequently refer to this objective as a “holy grail” because of its potential to individualize treatment and optimize outcomes, he continued. Successes achieved in other malignancies, such as prostate cancer, have demonstrated that genomic markers can provide valuable information about disease biology and help guide therapeutic decision-making, he noted. These advances have fueled efforts to identify similar predictive markers in RCC.

At present, it is very difficult to accurately determine which patients are most likely to benefit from neoadjuvant systemic therapy, Croll explained. Although this approach has become a standard component of care for many patients, responses vary considerably, he noted. Some individuals experience substantial benefit, with significant tumor regression and improved outcomes, whereas others derive little advantage from treatment, he added. Despite these differences, there are currently limited tools available to predict which patients will respond favorably and which will not, he said.

This lack of predictive capability creates a significant challenge in clinical practice. Patients who are unlikely to benefit from systemic therapy may be exposed to unnecessary toxicity and delays in definitive surgery without achieving meaningful improvements in outcome, Croll said. Conversely, patients who are likely to respond could potentially gain substantial benefit from neoadjuvant treatment, making accurate identification of these individuals critically important, he added.

Researchers hope that future advances in genomic profiling and biomarker development will enable a more personalized approach to treatment selection, Croll said. Ideally, these tools would distinguish patients who are likely to benefit from systemic therapy from those who should proceed directly to surgery because additional treatment is unlikely to improve their prognosis, he said. In addition to predicting therapeutic response, such biomarkers could provide important prognostic information regarding the expected course of disease, he concluded.