Based on recent estimates, kidney cancer accounts for approximately 4% of all cancer diagnoses in the United States. An estimated 65,300 new cases are reported each year and more than 14,000 people die of the disease. Renal cell carcinoma (RCC), which comprises nearly 90% of all kidney cancers, is characterized by a lack of early warning signs, diverse clinical manifestations, and resistance to radiation and chemotherapy. As a result of its often asymptomatic presentation, many patients present with advanced disease, which is associated with poor outcomes. The 5-year survival rate for patients with regional RCC is only 67%, and drops to a dismal 12% for those with distant metastases. In this interview, Brian I. Rini, MD, FACP, professor of medicine at Cleveland Clinic Lerner College of Medicine, discusses the need to personalize therapy for individual patients with RCC and the practice-changing potential of emerging immunotherapy data.
What are some of the most challenging aspects of managing advanced renal cell carcinoma (RCC)?
Brian I. Rini, MD, FACP: That's a big question. We're in an era where we're moving toward immune-based combination therapies. One of the challenges has been finding the right therapy for specific patients based on factors such as biomarkers and clinical features and choosing among the many therapeutic options that are now available.
What are best practices that you recommend to community oncologists who are also managing advanced RCC?
Dr. Rini: I recommend becoming familiar with the new drugs and regimens and developing a comfort level with one or more of these regimens so that they can be appropriately implemented in practice, including when to hold drug and when to dose-adjust. That only comes with experience, just like when TKIs were introduced many years ago. You didn't have to know all of the regimens, but you needed to know at least some of the regimens well.
What questions to do you commonly encounter from patients about their treatment and how do you counsel them?
Dr. Rini: Patients want to know the success rate, which is defined differently for each individual patient. They want to know the chance of responding, chance of cure, longevity, and life expectancy. So, I counsel them based on the existing clinical trial data.
What are some promising advances in RCC treatment that you expect to see in the near future?
Dr. Rini: There are new combinations of immune-based therapies coming out. There's going to be a lot of new data over the next year or two that's going to dramatically change how we approach patients.
Is there anything else that you would like to add for community oncologists who are treating RCC?
Dr. Rini: I think the mindset of approaching kidney cancer is going to be different, where we're going to treat patients more aggressively upfront for cure as opposed to just palliating them and then trying to control disease with targeted therapy. I don't know what the percentage will be, but we are going to be able to cure patients who have metastatic kidney cancer.
About Dr. Rini:
Brian I Rini, MD, FACP, is a professor of medicine at Cleveland Clinic Lerner College of Medicine. Dr. Rini's research interests include renal cell carcinoma and prostate cancer, with a focus on immunotherapy and antiangiogenic therapy. He is a member of several professional organizations such as American Society of Clinical Oncology, American Urologic Association, and Society of Immunotherapy of Cancer. In addition, he has co-authored more than 200 peer-reviewed publications and has presented his research at various national and international conferences.
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