Dr Karam on Key Kidney Cancer Takeaways From the 2023 IKCS

Jose A. Karam, MD, FACS, professor, Department of Urology, Division of Surgery, associate professor, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, discusses key takeaways from the 2023 International Kidney Cancer Symposium (IKCS).

At the 2023 symposium, Karam states that there were numerous sessions, one of which delved into variant histologies, specifically translocation, in kidney cancer. Various discussions explored the nomenclature and distinct molecular features defining this variant, along with available treatment options, Karam begins. Another noteworthy session, showcasing collaboration between academia, industry, and the FDA, focused on the journey of a particular drug—from its inception to its progression through clinical trials, its FDA approval, and its utilization in clinical settings over the past few years, he explains. Observing the evolution from the drug's biological rationale to its FDA approval and application in patient care was insightful, Karam emphasizes. Twoexceptional sessions centered around case discussions, offering specific scenarios—1 involving a patient with a solitary kidney with a large tumor and another featuring a patient with thrombus, he adds.

The sessions at IKCS featured debates between urologists, medical oncologists, and radiation oncologists, underscoring the importance of interdisciplinary collaboration, he continues. The discussions generated valuable ideas, emphasizing the necessity for clinical trials comparing different modalities and the importance of thoughtful trial design, including patient selection criteria and relevant clinical trial end points. Numerous unresolved questions persist in the field, such as the optimal timing of and candidates for neoadjuvant therapy in kidney cancer, the optimal selection of drugs or combinations, and the optimal duration of treatment, Karam explains. Questions also arise regarding whether combining adjuvant therapy with neoadjuvant therapy before surgery, a treatment approach similar to practices for patients with melanoma, yields better outcomes, and which patients are suitable candidates for this treatment approach. The need for new trials in the adjuvant setting remains an essential consideration, he notes.

Further, discussions at the meeting highlighted the need for clinical trials in radiation oncology, specifically regarding the irradiation of renal masses, Karam continues. Unanswered questions include the definitions of clinical trial end points, methods to measure therapeutic success, and eligible patient populations for such trials, he emphasizes. These unresolved issues underscore the importance of forums such as this meeting, which bring together experts to collaboratively address the best approaches to designing clinical trials, ultimately enhancing clinicians’ abilities to guide patients throughout their disease, Karam concludes.