6 Kidney Cancer Journal
T A B L E O F C O N T E N T S
Take-Home Message on Treatment Choices:
Drill Down Into the Data to Find the
“Devil in the Details”
hen oncologists gather in late April at the 17th
International Kidney Cancer Symposium (IKCS)
in Prague, they will be exploring a myriad of
investigative directions, options for therapy, and cutting
edge concepts, in many cases, picking up on themes featured
at the recent GU ASCO meeting in San Francisco.
If there was one consistent theme emerging from GU
ASCO—one that has long stood at the center of the narrative
on treating renal cell carcinoma (RCC)—it is the need
to identify predictive biomarkers to help us determine optimal sequential
and combinatorial therapies. This is often referred to as the “holy grail” of
our quest for optimizing outcomes and although expectations remain high
for such a discovery, the reality sets in and we know validating such
biomarkers is still daunting.
Nevertheless, this will only serve to again fuel the vigorous debate that
will challenge attendees at the IKCS, sponsored by the Kidney Cancer Association.
Until these reliable biomarkers emerge, we need to direct much of
our attention to the nuances in treatment approaches covered at GU ASCO.
In that sense, I suggest we get beyond the excitement generated by recent
approvals and assiduously drill down into the data to find the “devil in
the details”, so to speak. And one does not need look very far. By that
I mean consider all of the cautionary tales that surround the proposed
“treatment paradigms” for first line and second line therapies. This is not
to diminish what has been proposed by groups like the National Comprehensive
Cancer Network (NCCN). It’s more a question of remaining
mindful—and vigilant—of those details often overlooked when applying
the data to clinical practice.
There are numerous examples of such settings. For example, consider
the implications from the 2017 ESMO conference where data from Check-
Mate-214 emerged. If one were to unqualifiedly accept the findings without
drilling down into the data, as proposed earlier, should all patients receive
the combination of nivolumab and ipilimumab over sunitinib? As an Editorial
in ASCO’s daily news summary suggested, unique patient-related
characteristics provide a rationale for choosing one agent, or a combination
of agents, over another. With due diligence, you would consider the criteria
Editorial Mission
The purpose of Kidney Cancer Journal is to serve as a comprehensive
resource of information for physicians regarding
advances in the diagnosis and treatment of renal cell carcinoma.
Content of the journal focuses on the impact of translational
research in oncology and urology and also provides a forum for
cancer patient advocacy. Kidney Cancer Journal is circulated to
medical oncologists, hematologist-oncologists, and urologists.
Editor-in-Chief
Robert A. Figlin, MD, FACP
Steven Spielberg Family Chair in Hematology Oncology
Professor of Medicine and Biomedical Sciences
Director, Division of Hematology Oncology
Deputy Director, Samuel Oschin Comprehensive
Cancer Institute
Cedars-Sinai Medical Center
Los Angeles, California
Medical Advisory Board
Michael B. Atkins, MD
Deputy Director
Lombardi Comprehensive Cancer Center
Professor of Oncology and Medicine,
Georgetown University Medical Center
Washington, DC
Ronald M. Bukowski, MD
Emeritus Staff & Consultant
CCF Taussig Cancer Center
Professor of Medicine
CCF Lerner College of Medicine of CWRU
Cleveland, Ohio
Robert J. Motzer, MD
Attending Physician
Memorial Sloan-Kettering
Cancer Center
New York, NY
Christopher G. Wood, MD, FACS
Douglas E. Johnson, MD Professorship
Professor & Deputy Chairman
Department of Urology
M.D. Anderson Cancer Center
Houston, Texas
Nurse Advisory Board
Nancy Moldawer, RN, MSN
Nursing Director
Cedars-Sinai Medical Center
Samuel Oschin Comprehensive Cancer Institute
Los Angeles, California
Laura Wood, RN, MSN, OCN
Renal Cancer Research Coordinator
Cleveland Clinic Taussig Cancer Center
Cleveland, Ohio
Patient Advocate
William P. Bro
Chief Executive Officer
Kidney Cancer Association
Publishing Staff
Stu Chapman, Executive Editor
Jenny Chapman, Director, Business Development
Gloria Catalano, Production Director
Michael McClain, Design Director
Business and Administration Office
333 E. 75th Street, Suite 5D
New York, NY 10021
Editorial Offices
Genitourinary Publishing
2557 Tulip Street
Sarasota, FL 34239
Tel: (516) 356-5006
© Copyright 2018 Genitourinary Publishing. All rights reserved.
None of the contents may be reproduced in any form without the
permission of the publisher.
About the Cover
Illustration depicts clinical manifestations of von Hippel-Lindau
(VHL) disease. Affected persons are at risk for tumor development
in the CNS, pancreas, adrenal gland, kidney, and reproductive
system. Recommended periodic evaluations are also indicated.
(Image courtesy of Thai H. Ho, MD)
8 Journal Club
9 Medical Intelligence
10 Revisiting the VHL Connection: How a Common Pathway Now More
Closely Links Sporadic RCC, VHL-Associated Syndromes
17 The Classification and Treatment of Non-Clear Cell Renal Cell Carcinoma
26 Late Relapsing RCC: A Brief Review Suggests Expected PFS and
OS 5 Years and Beyond After Nephrectomy
G U E S T E D I TOR ’ S M E M O
(continued on page 29)
Roberto Pili, MD
W