Focus: localized, locally advanced, and advanced kidney cancer
Presenters:
Dr. Martin Ball (NCI) - Genetics and surgical management of kidney cancer
Dr. David McDermott (Beth Israel Deaconess) - Advanced management, particularly clear cell renal cancer
Dr. Rahm Cervasin (NCI) - Management of non-clear kidney cancers and drug treatments for localized disease (e.g., VHL targeting, HIF-2)
Interactive Poll
Poll test instructions:
Text to 22333
Body: k johnson o8o
Example question: What do you like most about New Orleans?
Options: A) AUA, B) Creole/Cajun food, C) French Quarter, D) Bourbon Street
Pre-Test Questions
Surgical management of a 26-year-old with VHL and bilateral multifocal RCC, largest tumor 2 cm: A) Right nephrectomy, B) Bilateral nephrectomy, C) Partial nephrectomy, D) Active surveillance
Tumor enucleation for RCC best suited for: A) Multiple comorbidities and a small renal mass, B) Biopsy suggests high-grade features, C) Multiple renal tumors, D) Infiltrative renal mass
Lymphadenectomy for RCC indicated in: A) All patients with cT2+ tumors, B) With renal sinus fat invasion, C) Enlarged interaortocaval node, D) Biopsy-proven papillary type 1 RCC
Upfront cytoreductive nephrectomy option for: A) Small volume metastatic disease, B) IMDC poor risk, C) Low performance status, D) Multiple organ metastases
Response to PD-1 therapy associated with: A) Tumor mutation burden, B) Sarcomatoid histology, C) T effector gene expression, D) PBRM1 gene mutation
Genetic Basis and Surgical Implications
Historical approach vs. current understanding
Kidney cancer as multiple diseases with different genetics, clinical courses, and responses to therapies
Importance of genetics for tailored management:
Active surveillance vs. surgery
Type of surgery: robotic vs. open, enucleation vs. wide margins
Treatment options post-surgery
Case Studies and Surgical Approaches
Von Hippel Lindau (VHL) Disease
VHL gene mutation leading to clear cell renal carcinoma (ccRCC)
Historical surgical management: active surveillance until tumors reach 3 cm; then partial nephrectomy
Enucleation techniques: nucleation without wide margins
Case: Patient with multiple renal tumors, successfully managed with partial nephrectomy
Sporadic Non-Inherited ccRCC
Case: Biopsy showed clear cell RCC with a VHL mutation
Considerations for nucleation vs. wide excision
Advanced and Metastatic ccRCC
Pathway understanding: VHL protein's interaction with HIF
FDA approval of 9 drugs targeting this pathway
HIF-2 inhibitors showing promise
Hereditary Papillary Renal Carcinoma (HPRC)
MET gene mutation
Active surveillance until tumors reach 3 cm
Case: Managing multiple multifocal tumors
FH Gene-Related Kidney Cancers
Fumarate Hydratase (FH) deficiency
Importance of wide resection margins
Case: Small tumors with invasion, aggressive surgical approach
Precision Surgery in RCC
Predictors for open vs. robotic, enucleation vs. wide excision, clamping vs. non-clamping
Managing multifocal, complex cases, and balancing functional outcomes
Importance of continuous adaptation based on individual patient and tumor characteristics
Cytoreductive Nephrectomy
Indications and outcomes
Considerations for upfront vs. systemic therapy
Importance of clinical trials and evolving guidelines
Recent Advances and Immunotherapy
Contribution of Dr. David McDermott
Targeted immunotherapy combining PD-1 inhibitors with other therapies
Biomarkers and durable responses
Evolving role of immune therapy in RCC management
Future Directions in Genetic and Targeted Treatments
Insights from Dr. Rahm Cervasin
Understanding molecular subtypes for personalized therapy
Impact of systemic therapies on historically difficult-to-treat forms like HLRCC
Promising results from novel agents
Conclusion
Integration of genetic understanding with clinical management advances
Importance of multi-disciplinary approaches in RCC management