risk of progression or death (hazard ratio 0.66; 95% CI
0.46-0.95 P =0.012) was seen with Cabozantinib 14. This
represents another significant stride given the unmet
need of this adverse risk group.
Conclusion
There has been definite stride in the survival outcome
among patients mRCC through therapeutic exploitation
of the VEGF-pathway in recent decade. However the benefit
of the commonly utilised agents such as sunitinib
and pazopanib so far has been largely limited to patients
with Favourable prognostic risk. The strikingly discrepant
outcome defined by prognostic risks emphasises the importance
of risk-stratifying mRCC patients in clinical
practice and personalising appropriate treatment based
on this.
The arrival of newer and more effective treatments
and combination offers optimism to improving survival
outcomes of mRCC patients particular those of I/P risk
groups. Better understanding of differential underlying
immune versus vascular-driven disease process through
relentless translational research and biomarker-based
treatment personalisation will be the next crucial step in
advancing the care of our patients.
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List of Abbreviations
TKI = Tyrosine Kinase Inhibitor; NHS = National Health Service; NICE=
National Institute for Health and Care Excellence; ECOG PS = Eastern
Cooperative Oncology Group Performance status; mRCC= Metastatic
Renal Cell Carcinoma; VEGF= Vascular Endothelial Growth Factor;
MSKCC= Memorial Sloan-Kettering Cancer Centre; ORR= Overall Response
Rate; ONS = Office for National Statistic; CR = Complete Response;
CRR= Complete Response Rate; SD= Stable Disease; PR = Partial
Response; PD = Progressive Disease; PD1 = Programmed cell death 1;
EORTC= European Organisation for Research and Treatment of Cancer;
HD-IL2 = High Dose Interleukin 2; UK = United Kingdom. KCJ
Except for the sarcomatoid variant of RCC, for which immune
based therapy is effective, the practical utility of
biomarkers to select therapy remains what some observers
have called “the unattainable holy grail” in kidney cancer.
As we look toward, still other unresolved issues remain
to be addressed in 2020. There is the need to consider subsets
of patient populations for whom the treatment algorithm
requires more clarification. For example, patients
who present with both synchronous metastatic disease
and primary tumor together constitute a group who deserve
systemic therapy as part of a front-line approach.
This population tends to be underrepresented in clinical
trials and a majority of them who are enrolled in such studies
receive nephrectomy instead of upfront immunotherapy
based approaches that would yield an equally favorable
benefit. The editors look forward to exploring new results
on this and other critical issues.
On behalf of the Kidney Cancer Journal and its Board of
Editors, I wish you a new year filled with an improved
outlook for your patients as we integrate knowledge gained
from symposia such as the IKCS and look forward to
clinical applications.
Ulka Vaishampayan, MD
Guest Editor
Chair, Division of Soilid Tumor Oncology
Director of Phase 1 Therapeutics
Karmanos Cancer Institute
Charles Martin Endowed Chair, Professor of Oncology
Wayne State University, Detroit, Michigan
EDITOR’S MEMO
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