Patient selection: crucial in RCC treatment

With the entry of so-called targeted therapy (TT), patient selection and individualised treatment strategies will become more crucial in the coming years in treating kidney cancer patients who have either localised or metastatic disease, according to experts who examined today current kidney cancer issues.

“We had a very balanced session where we looked for optimal treatment modalities in kidney cancer patients. If we can accomplish that (optimal approaches) then there is clearly a benefit for patients with both localised and metastatic disease,” said Prof. Peter Mulders (NL), chair of the session on ‘Choice of treatment for Renal Cancer.’

“With all the new treatment options from surgical to medical, even with laparoscopy and robotics, and targeted agents for systemic disease, the crucial step now is to identify the right sequence between surgery and systemic therapies,” Mulders told the EUT.

Speakers Prof. Alex Bex (NL) and Dr. Thomas Powles (UK) both underscored the need for individualizing therapy based on molecular markers. “There is that need for individualising therapy based on molecular markers… but the problem is we can’t identify patients upfront,” said Powles. He noted that there are several markers under evaluation such as germ-line material, plasma and tissue which have all been collected and analysed.

Powles said the study results are, however, mixed with some markers still needing additional investigation. Bex, meanwhile, stressed in his lecture that patients selection will prove crucial.

“It’s all about selection,” Bex said. In his concluding remarks he underscored the following:- There is no evidence supporting the use of adjuvant therapy for patients with high risk of recurrence after nephrectomy. Multiple phase 3 trials are ongoing;- There are no phase 3 trials investigating neoadjuvant therapy for high-risk disease;- The effect of neo-adjuvant therapy to downsize tumours, metastases and CVT (caval vein thrombus) is limited with the available targeted agents and maybe higher with more selective TKI (tyrosine kinase inhibitor).

In comments made to the EUT, Mulders said: “We have to monitor these patients and add these markers and also implement a protocol for the various treatment modalities; so that we can exchange the results and learn from each other what kind of treatment is best for what kind of patient.”