ASCO 2018: Highlights From the Meeting
Through the Lens of a Key Opinion Leader
In this wide ranging interview, Nicholas J. Vogelzang, MD, FASCO,
FACP, shares insights, perspectives, and real-world observations from his
practice following the 2018 Scientific Sessions of the American Society of
Clinical Oncology. Dr Vogelzang serves as Vice Chair of the SWOG GU
Committee and is Associate Director, Genitourinary Research Program,
US Oncology Research, Comprehensive Cancer Centers of Nevada, in
Las Vegas. He recently was recognized as one of 21 physicians for their outstanding
contributions to quality care and inducted as a Giant in Cancer Care by OncLive.
Q. What impression were you left with after the 2018
ASCO meeting? Was there anything with significant
translational impact?
Dr Vogelzang: I did not find any breakthroughs at this
year’s meeting, nothing that I could describe as “practice
changing.” With regard to CARMENA, one of the trials
discussed during the Plenary Session, the data did not
change my practice. I’ve always recommended a neoadjuvant
TKI (tyrosine kinase inhibitor) for the last 10 years
because of some traumatic experiences early on when
everyone was recommending upfront nephrectomy regardless
of risk factor stratification or selection considerations.
In some cases, patients died before they could
receive systemic therapies. I don’t recommend nephrectomy
upfront unless the tumor is really small or there is
minimal metastatic burden.
Q. There has been a lot of controversy surrounding this
issue. There are physicians, for example, especially at academic
centers like the Massachusetts General Hospital,
who say that cytoreductive nephrectomy has been largely
underused in the targeted therapy era and that strategies
should be reconsidered. What is your opinion of these
observations?
Dr Vogelzang: I think that physicians at these centers, particularly
urologists, do not see the kind of kidney cancer
patients whom most of us in community practice see. The
problem often arising for community oncologists is that
patients are sick when they come to us; they are symptomatic
and should not have their kidney removed initially.
It’s obvious that when you have clinical experience
under your belt, the TKIs work extremely quickly to reduce
pain and bleeding.
50 Kidney Cancer Journal
Q. Can you provide a real-world experience where this
was the case?
Dr Vogelzang: Yes. A prisoner was brought to my office recently
and he came in with a palpable mass and in severe
pain. He had been shuttled around from one doctor to
another and had undergone a biopsy but no treatment.
When he walked into my office he was in shackles. After
examining him, I told him, “You need to start a TKI right
now.” So I went to my samples and selected Votrient,
which I had available at the time. Within two days his
pain was gone, his mass was smaller, evidence that the
TKI was working extremely quickly. Unfortunately, the
patient died because he could not find a surgeon who
would operate on him because it was inoperable. The
point of this case, however, is the rapidity with which
TKIs reduce inflammation, the pain, and reduce peritumoral
infiltrates. It is really remarkable.
Q. So to sum up the controversy on initial cytoreductive
nephrectomy in the targeted therapy era, is there anything
recent in the literature that can serve as a guide,
aside from society or working group guidelines?