BackTable / Urology / Podcast / Episode #56

Adjuvant Therapy for Advanced Kidney Cancer: Who, What, When

with Dr. Rana McKay and Dr. Karim Bensalah

In this episode of BackTable Urology, Dr. Aditya Bagrodia speaks with urologist Dr. Karim Bensalah from the Universitaire de Rennes and medical oncologist Dr. Rana McKay from UC San Diego about adjuvant therapy for advanced kidney cancer.

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Adjuvant Therapy for Advanced Kidney Cancer: Who, What, When with Dr. Rana McKay and Dr. Karim Bensalah on the BackTable Urology Podcast)
Ep 56 Adjuvant Therapy for Advanced Kidney Cancer: Who, What, When with Dr. Rana McKay and Dr. Karim Bensalah
00:00 / 01:04

BackTable, LLC (Producer). (2022, September 21). Ep. 56 – Adjuvant Therapy for Advanced Kidney Cancer: Who, What, When [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Rana McKay discusses Adjuvant Therapy for Advanced Kidney Cancer: Who, What, When on the BackTable 56 Podcast

Dr. Rana McKay

Dr. Rana McKay is a medical oncologist and associate professor at UC San Diego Health in California.

Dr. Karim Bensalah discusses Adjuvant Therapy for Advanced Kidney Cancer: Who, What, When on the BackTable 56 Podcast

Dr. Karim Bensalah

Dr. Karim Bensalah is a professor of urology with the Universitaire de Rennes in France.

Dr. Aditya Bagrodia discusses Adjuvant Therapy for Advanced Kidney Cancer: Who, What, When on the BackTable 56 Podcast

Dr. Aditya Bagrodia

Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.

Show Notes

First, the doctors discuss when to bring up adjuvant therapy. All three doctors agree that having the discussion early with patients is helpful to the patient and other specialties involved if the cancer is expected to be aggressive after reviewing initial imaging. Dr. Bensalah usually waits until the final pathology results arrive in order to determine the specifics of the adjuvant therapy treatment and refer his kidney cancer patients to medical oncology. He does not use nomograms if the patient does not ask for specific rates of recurrence. However, Dr. McKay uses nomograms often.

Next, the doctors discuss different oncological factors that may convince them to start their patients on adjuvant therapy, such as a large tumor size, advanced tumor stage/grade, an IVC thrombus, extrarenal metastases, and nodal involvement. Additionally, patients with multiple comorbidities and elderly patients may benefit from adjuvant therapy. Both Dr. Bagrodia and Dr. McKay agree that genomic sequencing of tumors is not helpful in making the decision to start adjuvant therapy, as there needs to be more research around this topic. Dr. Bensalah then explains the difference between approval and billing of tyrosine kinase inhibitors (TKI) in Europe.

Finally, the doctors discuss different clinical trials centered around the TKI Pembrolizumab (Keytruda). Dr. McKay notes that there have been very few positive trials and that she is reluctant to put her patients under a year of toxicity if there is a chance of overtreatment. Although many people have few mild side effects, severe side effects, such as diabetes, colitis, and fingernail necrosis, can be observed. Finally, the doctors discuss the importance of generating more research on the response of non clear cell renal carcinomas to adjuvant therapy. Currently, all these cancers are classified as one category but have different histology and response to therapies.

Resources

Register for the 2022 International Kidney Cancer Society Symposium:
https://www.kcameetings.org/2022-ikcs-north-america/

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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