Robert G. Uzzo, MD
Management of patients with localized kidney cancer became a more uniformed, guided, and evidence-based approach earlier this year with revised guidelines individually developed by the American Society of Clinical Oncology (ASCO), American Urological Association (AUA), and the American College of Radiology (ACR).
on Renal Cell Carcinoma and Bladder Cancer. In an interview at the event, he honed in on recent guidelines that have impacted clinical practice and ongoing biomarker research in the field.
OncLive: What did you discuss in your lecture regarding localized kidney cancer?
The management of localized kidney cancer is increasingly complicated. Over the course of the last couple of years, we have developed more guidelines. It is not just a matter of when the surgery ought to be or how it’s going to be performed if surgery is indicated. We spoke about excision, ablation, and observation as the most common paradigm for [how] you should treat kidney cancer. What I spoke about is what ASCO, AUA, and ACR say about that. I should disclose that I was part of all 3 of those guidelines.
What are the specifics of those guidelines?
There is an increased emphasis on biopsy to determine and risk stratify prior to any plans for excision, ablation or even observation. The use of percutaneous biopsy, particularly core biopsy as a risk-stratifying tool, is an important aspect. Many physicians believe that biopsy is associated with a risk of tumor spillage which, fortunately, is not the case. It is more anecdotal and older data. Biopsy does not seem to be associated with a higher risk of tumor dissemination or seeding.
[We’re not only looking at] active surveillance and risk stratification for tumor risks but also comorbidities, life expectancy, and some of the risks that patients incur just when going to surgery. We’re balancing those risks when making appropriate decisions—empowering patients to understand all of those aspects of decisions, and, not just when the surgery ought to be, but balancing all of those risks to see who should be excised, ablated, or observed.
Where does surgery fit into the future treatment landscape of kidney cancer?
Surgery will always have an important role in the management of kidney cancer until we have completely effective systemic therapies, which we don’t. As systemic therapies grow more effective, then surgery [will have] less of a role. If you have a systemic therapy that can cure metastatic kidney cancer, then surgery is going to have a small role. However, we're not even close to that.
Where all of this goes is to risk stratification. We need a better understanding that some kidney cancers are never destined to metastasize and are better to be [observed]. With genomic profiling and improved biomarkers, perhaps we will have a better idea. The role of surgery is getting refined, just like it is with all malignancies. Organ-sparing surgeries are becoming increasingly emphasized, and the complexities of minimally invasive surgery are being emphasized.
Where are we currently with biomarker research?
Biomarkers for kidney cancer currently don’t exist. There are a number of serological markers that people have looked at—neutrophil counts, lymphocyte counts and ratios, C-reactive proteins, and other types of serum biomarkers—that are easy to measure but are not sensitive or specific enough.
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