EMUC14 Interview: Surgery remains the gold standard for high-risk kidney cancer

Surgery remains by far the most effective treatment for kidney cancer patients despite the advent of so-called targeted therapies, and cancer experts agree that more studies are needed in the field of molecular or genetic studies to boost emerging non-surgical therapeutic options.

“Surgery remains the only consistent “cure” for renal cancer. The role of surgery even for patients with metastatic disease in the targeted therapy era is assuming a more important role as progression-free survival improves,” said Prof. Michael Blute of the Massachusetts General Hospital (Boston, USA).

Blute will lecture during the session on renal cell carconoma in the upcoming 6th European Multidisciplinary Meeting on Urological Cancers (EMUC). The 6th EMUC, held annually since last year, will be held in Lisbon, Portugal from November 13 to 16. With experts from both sides of the Atlantic, EMUC’s scientific programme assesses recent developments, progress and prospects in both research and clinical work on urological malignancies.

Blute added that although medical treatment options gained significant advances in recent years, these developments have not diminished the crucial role of surgery. “With the advent of important prognostic algorithms, such as the Motzer or Huang criteria, we have powerful tools to predict which patients are most likely to benefit from aggressive therapies to include surgery,” he explained.

With an aggressive disease such as kidney cancer which has eluded curative treatment approaches, urologists have the lead and crucial role in a multi-disciplinary setting, experts say. Although chemotherapy and other systemic medical treatment options have a role, Blute noted their effect or impact are limited and remains debatable.

“The extent of cytoreductive surgeries remains controversial even for patients with high-risk local disease and clinically benign lymph nodes. In regional control, the retroperitoneum has been a difficult relapse site, historically, to manage and resistant to systemic therapies. In addition to improved staging, multi-variable analysis status of regional nodes is an important predictor of survival in terms of application of metastasectomy,” he explained.

Regarding progress in scientific studies, Blute remains optimistic of breakthrough advances.

“I am enthusiastic about the application of ‘immune checkpoint inhibitor therapies’ such as anti CTLA4 or PD-1 inhibition in sequence with or combined with targeted therapy. Hopefully, FDA approval of anti CAIX contrast agents for evaluation/staging of small renal masses will improve our ability to individually manage clear cell cancer,” according to Blute.

He also noted other crucial research findings that would help uro-oncologists. “Recent research is revealing important biologic information regarding follicular hyperplasia in the absence of evidence of metastatic involvement, that is., the presence of circulating marrow- derived immunosuppressive cells, and T or CD cell population studies may provide information regarding the extent of cancer immunosuppression by the individuals’ RCC (renal cell carcinoma),” he added. Besides research work on prostate and kidney cancers, Blute said he would also welcome more advances in targeted or immunotherapy for managing urothelial cancer. “These (studies) will greatly add to platinum-based strategies for advanced bladder cancer,” he pointed out.

At the same time, he noted the work of groups like The Cancer Genomic Atlas (TCGA) in providing a library of mutational changes that may be drivers of malignancies such as bladder and kidney cancers. “Recently, a specimen tumour RNA sequencing snapshot at our MGH (Massachusetts General Hospital) cancer center identified two mutations, described by TCGA in one of my patients with advanced bladder cancer, that are possible therapeutic targets,” he disclosed.

Meetings such as the EMUC, according to Blute, are also indispensable opportunities that greatly help and advance the agenda of medical and scientific communities.

“I believe meetings such as the EMUC provide foundational validity for integrating surgery with oncology practices. Exchange of ideas and best practice always lead to further opportunities for discovery, enhancing the field of GU oncology, “ said Blute.

For details on registration, abstract submission and the EMUC programme, please visit the meeting website!