T A B L E O F C O N T E N T S
Reassessing the Value
of IO Treatment as the
‘Fifth Pillar’ of Cancer
Therapy
ne of the phrases integrated into our lexicon over
the last several years suggests that immunotherapy
(IO) has become the ‘fifth pillar’ of cancer therapy—
enhancing the first four of surgery, chemotherapy, radiotherapy
and targeted therapy. If IO is the fifth pillar in
that regard, then in the treatment of renal cell carcinoma
(RCC), it is now the cornerstone as new regimens vie for
the frontline space in metastatic RCC.
While the field of IO has advanced significantly, supported
by pivotal trials like JAVELIN Renal 101, Check-
Mate-214, and KEYNOTE-426, much more knowledge is
needed to achieve a future where the potential benefit of these therapies
can be maximized for the greatest number of patients. Key questions
remain about how to select those patients who are most likely to respond
to IO therapy, how to combine IO therapies with one another and with
other treatment modalities, how to predict, limit, and mitigate IO treatment
related toxicities, how to reduce resistance to IO therapies, how to
use these therapies in newly defined standards of care and when to stop
treatment. Some of these questions are addressed in this issue’s Round
Table discussion with three experts whose knowledge of the pivotal IO
studies offers key perspectives on the IO-TKI combinations promoted as
part of the standard of care.
As much as the IO combinations have filled the treatment space, there
is another narrative ongoing that also should capture our attention, although
it may not serve as a focus as much as the clinical story. And in the
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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333 E. 75th Street, Suite 5D
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Editorial Offices
Genitourinary Publishing
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Copyright © 2019 Genitourinary Publishing. All rights reserved.
None of the contents may be reproduced in any form without
the permission of the publisher.
About the Cover
Mechanisms, surgery, targets, combination therapy. All of
these are featured in this issue as part of a broad range of topics
covering the latest information to emerge on the treatment of
renal cell carcinoma.
64 Journal Club
65 Medical Intelligence
67 KCA Announcements: Inaugural RCC ‘Think Tank’ Could Refocus
Kidney Cancer Research
68 Flare Phenomenon or Pseudoprogression During ICI Therapy in RCC:
Potential Value of Treatment Beyond First Progression
74 Case Repor t: Targeting Glutamine Metabolism—from the CANTATA Trial
76 Reality Check : What Is the Latest Paradigm for Cytoreduc tive
Nephrectomy vs Targeted Therapy in mRCC?
81 Roundtable: Deconstructing IO Therapy : Three Combinations,
Three Viewpoints from Key Opinion Leaders
E D I TO R ’ S M E M O
(continued on page 73)
Robert A.
Figlin, MD
O
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