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Treatment options for renal cell carcinoma (RCC) have evolved dramatically in recent years, significantly improving patient outcomes. Immune checkpoint inhibitors (ICIs), tyrosine kinase inhibitors (TKIs), and doublet therapies have all become new standards. But these changes have also brought new uncertainties, noted the authors of a recent clinical commentary in JCO Oncology Practice.

In this interview, , director of Genitourinary Medical Oncology at the Cleveland Clinic's Taussig Cancer Institute, discusses her takeaways from the clinical review.

Following is a transcript of her remarks

I'm Dr. Shilpa Gupta. I'm a genitourinary urinary medical oncologist and the director for the genitourinary program at the Cleveland Clinic.

So Dr. Nataliya Mar and colleagues published a clinical review in the JCO Oncology Practice this month on 'Renal Cell Carcinoma -- Lessons in Diversity, Breakthroughs, and Challenges,' which is really very intriguing because the treatment for renal cell carcinoma has evolved dramatically in recent years with immunotherapy and targeted therapy combinations taking the main stage for frontline therapies.

And immunotherapy doublets are another option for frontline therapy and have been around the longest. And the optimal choice of therapy remains unclear. And we usually go by patient characteristics and can't really do cross-trial comparisons because of diverse study endpoints and variable patient populations. And the risk stratification algorithms were a big advancement like the International Metastatic RCC Database Consortium -- IMDC -- criteria, and the MSKCC [Memorial Sloan Kettering Cancer Center] models which were utilized for most of the trials these algorithms have been used.

However, these criteria were developed before the current standard of care because these were before the development of the immunotherapies and also the TKI therapies. And there's some subjectivity of time from diagnosis to start of treatment, as well as certain other inclusion criteria, which again can affect when the patients are starting therapy and not necessarily prognostic criteria per se.

So I think there's some limitations of these risk stratification algorithms, and the IMDC algorithm has been validated in the immunotherapy era as well. So that's certainly more applicable to our current treatment scenarios.

These criteria are primarily for patients with clear cell histologies, and the non-clear cell histologies are not specifically looked at in these. So that's one of the limitations. And while anytime a treatment gets approved for clear cell carcinoma in the real world, we still go to that treatment to use for non-clear cell patients, based on subgroup analysis and whatnot. But the algorithms, if we were to make it more applicable, I think that is something that should also be incorporated in these algorithms.

Read the clinical review here.

Read an interview about it here.