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Presentation Notes An Overview of the Proceedings Twelfth International Kidney Cancer Symposium John C. Cheville, M.D. reports on a new RCC subtype during the Symposium Clearcell papillary tubulopap

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 2 Dear Readers I am privileged to submit this patient summary of the 12th Annual International Kidney Cancer Symposium for your con

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 3 Table Of Contents 4 Update on Active Surveillance Michael A.S. Jewett, M.D. 6 Recognizing Morton A. Bosniak, M.D. 7 Debate RFAMic

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 4 Update on Active Surveillance Dr. Michael Jewett gave his assessment of where he felt the medical community is today in the pract

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 5 including pathologists, imagers, and others to interpret the collected tissue. Biopsies are usually performed using an 18 gauge c

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 6 Our triggers for treatment though are poorly understood at this time we tend to use size and kinetics. Kinetics is the estimated

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 7 A Comparison of Ablation Therapies CA, RFA MW Discussed RFAMicrowave is Best for Ablation Patients Fred T. Lee, M.D. University

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 8 With cyroablation the visible ice ball that is observed via imaging during treatment does not always equal the kill area which is

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 9 Dr. Atwell echoed the earlier comments on Dr. Lee that RF, MW, and cyroablation are all capable and pretty much equal in efficien

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 10 inability to distinguish between aggressive and more indolent tumors. Currently the accuracy level is below 85 in some situation

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 11 Dr. Lane cited the three main concerns for not performing a biopsy were the following Needle tracking this is an unfounded con

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 12 Michael D. Stifelman, M.D. NYU Langone Medical Center New York, NY We may potentially be improving the postoperative outcomes b

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 13 Summary and Case Presentations Kidney Cancer and Risk We have a cancer problem in this country... We are better at finding these

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 14 In medicine we have to educate for avoidable risks, communicate absolute risks, accept calculated risks, and study unexpected ri

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 15 Chronic Kidney Disease and Competing Comorbidities In the Management of Localized RCC Patients with kidney cancer can die from k

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 16 Nephrectomy for Larger Renal Masses There is essentially not a great deal of difference in partial and radical nephrectomies for

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 17 Management of IVC Thrombus An IVC thrombus may or may not block the flow of blood while most patients present with a constellati

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 18 Role of Lymph Node Dissection Vitaly Margulis, M.D. University of Texas Southwestern Medical Center Dallas, TX In a population

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 19 Followup of Patients After Surgical Treatment No single followup plan is appropriate for all patients therefore, individual foll

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 20 Summary and Case Presentation for Management of LocalizedLocally Advanced RCC Dr. Campbell summarized the segments on localized

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 21 Christopher G. Wood, MD, Honored By Kidney Cancer Association Delivers Novick Memorial Lecture at International Kidney Cancer Sy

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 22 Emerging Aspects in the Biology of RCC Translational Biology of RCC Whats Next James Brugarolas, M.D., Ph.D. University of Texa

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 23 Understand and exploit mutation heterogeneity. The study by Gerlinger at bottom of page can be good news and bad news. The good

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 24 Recognizing W. Marston Linehan, M.D. Urologic Oncology Branch Chief Center for Cancer Research National Cancer Institute Bethesd

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 25 AUC stands for area under the curve imagine the typical bell curve with efficacy on the left and toxicity on the right. The area

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 26 CardioOncology in RCC An Update Juan Carlos Plana, M.D. Taussig Cancer Institute Glickman Urological and Kidney Institute Clevel

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 27 Rana McKay, MD DanaFarber Cancer Institute Boston, MA Impact of Bone Metastases BM and Bisphosphonate use in Patients with Meta

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 28 At the end of Dr. McKays presentation she listed the following conclusions The presence of bone metastases is an adverse risk fa

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 29 Dr. Leibovich presented several cases for the panel and the audience to consider. While the following case and its outcome demon

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 30 Debate Cytoreductive Nephrectomy First This is not a blackandwhite issue but a continuum denying everyone cytoreductive nephrect

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 31 In the preTKI era before December, 2005 when there were few effective treatment options, nephrectomy was the standard of care fo

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 32 Lymph Node Dissection LND During Cytoreductive Nephrectomy CR In his opening remarks Dr. LaRochelle stated that this is a topic

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 33 Reasons not to do LND or CN in cNM clinically node positive with metastatic disease NM RCC has very poor prognosis Are these pat

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 34 Role of Metastasectomy Metastatic RCCEpidemiology 65,150 patients will be diagnosed with renal tumors in 2013 in the US 90 RCC 3

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 35 Retroperitoneum most common recurrent sites here are adrenal gland, fossia, lymph nodes 54 patients 5 Predictors of poor outcome

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 36 RCC The Role of the Pathologist Subtypes of RCC Clear cell renal cell carcinoma Papillary renal cell carcinoma Clear cell papill

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 37 30 of pathologists did not mention necrosis in their pathology reports and yet it is an important factor to report. Necrosis rar

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 38 A Joint Session on Immunotherapy James H. Finke, Ph.D. Department of Immunology Cleveland Clinic Taussig Cancer Institute Clevel

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 39 Tcell responders are powerful If you get a virus infection Tcells will mount a response and the next time a virus comes into you

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 40 We need presurgical tissue to understand what Tcells and other cells are doing in the tumor microenvironment, then later collect

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 41 Tumor cells arent stupid they can evolve away from the specific antigen being targeted by the Tcell response so the broader the

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 42 PD1 Pathway Immunotherapy If PD1 pathway immunotherapy makes it to the clinic there will be a relearning process by physicians t

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 43 PD1 pathway immunotherapy 2050 response rate in clinical trials Topalian et al., NEJM 3662443 2012 Effective in multiple tumo

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 44 Update Health Outcome Research in Advanced RCC Daniel Heng, M.D., MPH, FRCPC University of Calgary Tom Baker Cancer Center Calga

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 45 The International mRCC Database Consortium Currently includes 3300 patients from 23 institutions Intl mRCC Database Consortium

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 46 Implications we retrospectively looked at the response rate of patients that were treated with two VEGF inhibitors, a first line

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 47 Karnofsky Performance Status National Cancer Institute At the Eastern Cooperative Oncology Group we have some really large cli

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 48 Newer TKI Agents in the Front Line Setting Pro C. Lance Cowey, M.D. Texas OncologyBaylor Charles A. Sammons Cancer Center Dallas

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 49 Newer TKI Agents in the Front Line Setting Con Treatment Algorithm for New Clear Cell RCC Patient Assess Urgency of Treatment Re

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 50 HighDose IL2 Therapy FDA Approval 1992 Response Durations of 255 pts in 2002 15 response rate with durable responses in a small

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 51 Patient Selection for Upfront mTOR Inhibition Biologic Rationale Rationale for mTOR as a Therapeutic Target PI3KAktmTOR signalin

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 52 When you go to work and think about kidney cancer keep your passion Dr. Schonfeld was a very passionate man and I think his pass

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 53 In the 1980s there was a shift from cytotoxic chemotherapy to immunebased treatments. We saw some complete responses and partial

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 54 pathway in subsequent therapies. I know we have seen different things in this regard, but I dont think that we have asked the qu

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 55 One of the lessons I learned in the last seven years is it is sometimes very good to change institutions and you can say to your

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 56 Dr. Figlin has authored over 300 peerreviewed articles, more than 60 book chapters, and has published many books W. Kimryn Rathm

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 57 Existing Clinical Data of SecondLine and Greater Therapy in Advanced RCC An area of kidney cancer which has seen the most rapid

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 58 Trial data for everolimus indicated good application for second line therapy however consequent trials and indications are that

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 59 Sunitinib Rechallenge The response to a sunitinib rechallenge may depend on the time interval between usasge of the drug. The me

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 60 Update in the Biology of Resistance Disease Our challenge is that when we give a drug to a patient there is sometimes no respons

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 61 In instances where there has been a response and then resistance develops some of the resistance mechanisms may be transient. By

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 62 We have a lot of choices, but there are also limitations to all of our treatments what we really want are treatments that produc

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 63 PD1 Pathway Blockade Key Translational Questions Is PDL1 expression Influenced by prior systemic therapy Predictive of benefit

Twelfth Annual International Kidney Cancer Symposium 2013 Lawing 64 Commentary For What Its Worth THE HAUNTING CHALLENGE OF EUGENES BLACK BAG FOR ALL OF US Michael B. Lawing Patient Advocate KCA

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