T A B L E O F C O N T E N T S
Is Precision Medicine the Wave of the
Future or a C autionary Tale?
rom scientific symposia and journal articles to blogs, podcasts,
apps, teleconferences and roundtable discussions, the
term “precision medicine” seems to be as ubiquitous as the
daily unsolicited emails physicians generally delete on any number
of topics. Call it “precision medicine” or “personalized medicine,”
few avenues of clinical research in oncology have
generated as much excitement and hope. And yet, the entire
field is a cautionary tale. Yes, it has achieved some incredible
milestones over the years and is poised to bring us closer to enhanced
treatment strategies and improved outcomes. But how
Kidney Cancer Journal 103
much of the progress is illusory?
Precision medicine has had some setbacks, notably in efforts to bring forth
more effective vaccine strategies. For example, there have been three negative
trials thus far of viral vectors that test vaccines in kidney cancer, transgene
TG4010, MVA-5T4 and IMA901. These have, unfortunately, spanned the last
decade in testing so it has been problematic to determine which tumor antigens
are the optimal ones to target, which we should present to T cells to activate them,
and which particular tumor antigens we should go after. The transgene virus vector
presents a specific tumor antigen and there is one from the IMA901 study that
presents about 10 different tumor antigens, but they are all prespecified and offthe
shelf. There has been one from Argos Therapeutics that is a dendritic cell vaccine,
which takes both dendritic cells as well as tumor RNA from patients directly
and integrates those, so that, when infused into the patient, the dendritic cells
will activate the T cells based on the patient’s repertoire of tumor antigens.
That one showed promising results in the ADAPT phase 2 study and was undergoing
a phase 3 trial in combination with sunitinib in the first-line setting.
However, the company terminated its Phase 3 ADAPT trial assessing lead candidate
Rocapuldencel-T, combined with sunitinib/standard-of-care, in newly diagnosed
patients with metastatic renal cell carcinoma (RCC). The company made its decision
after interim results indicated poor prospects of success. Despite these disappointing
results, there are still more vaccine trials with reasonable prospects of
showing benefit and their data could provide encouraging data. Overall, it is far
too soon to rush to judgement on the viability of vaccines for kidney cancer. Too
soon to count them out, but the results generally have not given us much to cheer
about.
There is much more optimism surrounding the use of molecular biomarkers,
not only to unravel more of the unknown characteristics of the tumor microenvironment,
but to point the way toward improvements in prognostic models and
selection of therapies . We are moving past the time—with its roots in the interferon
era—when we rely primarily on clinicopathological variables like Karnofsky
status to shape prognostic models such as the International Metastatic Renal Cell
Editorial Mission
The purpose of Kidney Cancer Journal is to serve as a compre-
hensive 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
Robert J. Motzer, MD
Attending Physician
Memorial Sloan-Kettering
Cancer Center
New York, NY
Brian Rini, MD
Professor of Medicine
Cleveland Clinic Lerner College of
Medicine of Case Western
Reserve University
Cleveland, Ohio
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
Gretchen Vaughan
Chief Executive Officer
Kidney Cancer Association
Publishing Staff
Stu Chapman, Executive Editor
Jenny Chapman, Director, Business Development
Michael McClain, Design Director
Director of Advertising
Susan Hirschhaut
(847) 476-0588
susan@datamedica.org
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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
Given the biological heterogeneity of small renal masses (SRMs),
it is often difficult to determine preoperatively whether an SRM is
a benign lesion, an indolent malignant tumor, or, most worrisome,
an aggressive malignancy. SRMs like the 2.7 mass shown in this
axial view on CT, can be a diagnostic challenge. Artist's conception
suggests how lessons learned from the DISSM Registry may
illuminate various approaches and the extent to which active
surveillance can help guide decision making. Copyright © 2018
Science Source.
106 Journal Club
107 Medical Intelligence
108 Active Surveillance for Small Renal Masses: Lessons Learned over the
Past Decade with a Focus on the DISSRM Registry
113 ESMO 2018, IKCS Offer Report Cards on New Hypotheses, Real-World
Data in RCC
121 IKCS Recaps Impressive Progress in Ongoing Pivotal Trials and Projects
New Directions in Novel Therapeutics
127 2018 Index
E D I TO R ’ S M E M O
(continued on page 127)
Robert A. Figlin, MD
F
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