Clear Cell RCC: Testing Recommendations and Familial Risk

EP: 1.Patient Profile 1: Intermediate/Poor Risk RCC Treated With Ipilimumab-Nivolumab

EP: 2.I/O–I/O Therapy in Intermediate/Poor Risk RCC: Toxicity and Duration of Response

EP: 3.Triplet Therapy Approaches for Intermediate/Poor Risk RCC

EP: 4.Patient Profile 2: Favorable-Risk RCC Treated With Lenvatinib-Pembrolizumab

EP: 5.Risk Stratification and Factors in Selecting Therapy in RCC

EP: 6.Lenvatinib/Pembrolizumab in RCC: Dosing and Adverse Event Management

EP: 7.Patient Profile 3: RCC Treated With Adjuvant Pembrolizumab

EP: 8.Adjuvant and Neoadjuvant Therapies Under Evaluation for Renal Cell Carcinoma

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EP: 9.Clear Cell RCC: Testing Recommendations and Familial Risk

EP: 10.Patient Profile 4: Non–Clear Cell RCC Treated With Cabozantinib-Nivolumab

EP: 11.Non–Clear Cell RCC: Clinical Rationale Behind Therapy

EP: 12.Renal Cell Carcinoma: Future Directions in Care

Transcript:

Robert J. Motzer, MD: One question we frequently get from the patients regarding clear cell RCC [renal cell carcinoma] is if it’s inherited. “Should I be seen by clinical genetics?” Maria, is there a certain population of patients who you would recommend get evaluated by clinical genetics? Are there any guidelines that we should use in terms of making that decision?

Maria I. Carlo, MD:I tend to follow the NCCN [National Comprehensive Cancer Network] Guidelines. In the kidney cancer guidelines, there’s a section on who should be considered for genetic counseling. Broadly speaking, it should be patients with a family history, with a first- or second-degree relative with RCC; multifocal RCC, which is more than 1 RCC during their lifetime; and young patients. For young patients, the cutoff used for by NCCN is 46 years old, because based on data from NCI [National Cancer Institute] showing that if you tested patients under age 46, that would capture most of those with an inherited syndrome.

[We take a] very careful family history, asking the patient certain questions to see if there’s nothing else indicative of a genetic syndrome. For example, and we recently published these data, [we look at] the rate of pickup for a genetic condition in a young patient with a clear cell RCC and nothing else—no family history, obviously no hemangioblastomas or something to make you think of VHL [von Hippel-Lindau syndrome], no other conditions—is very low. But I do discuss it with them. I offer it. It’s a good exercise for them to take a comprehensive family history with a generic counselor. I counsel that it’s probably unlikely they have something, but it’s a good idea to take a detailed family history. It may be that there’s some genetic yet undiscovered cause for why young people get clear cell kidney cancers.

Transcript edited for clarity.