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The FDA approval of axitinib and pembrolizumab and of axitinib and avelumab expand our options to optimize combinatorial approaches, in addition to the approval of ipilimumab and nivolumab in 2018. And what about the other “points on the compass” identified earlier? Verification of biomarkers to help guide these choices remains arguably the most elusive goal and a formidable challenge we face. Innovative and novel approaches are emerging as more of the tumor microenvironment is revealed.

     Successful prognostication of patients is critical to both the clinical practice of oncology and research, as it influences treatment approaches and may be used to stratify patients in clinical trials. Classically, the most robust prognostic variables were related to histology (subtype, grade, tumor size), clinical features (performance status and pace of disease), or laboratory parameters. As nomograms utilizing these variables have come under closer scrutiny, we are seeing a dramatic evolution in how these models can be improved with underlying genomic information. The article in this issue of the Kidney Cancer Journal on precision medicine offers a striking perspective on how BAP1 and PBRM1 expression, for example, can potentially enhance these prognostic models. Yes, we are making progress on extending the frontier of biomarker applications but the limitations are still formidable to achieve truly personalized medicine. Except for the sarcomatoid variant of RCC, for which immune-based therapy is effective, the practical utility of biomarkers to select therapy remains what some observers have called “the unattainable holy grail” in kidney cancer.

     As we look toward, still other unresolved issues remain to be addressed in 2020. There is the need to consider subsets of patient populations for whom the treatment algorithm requires more clarification. For example, patients who present with both synchronous metastatic disease and primary tumor together constitute a group who deserve systemic therapy as part of a front-line approach. This population tends to be underrepresented in clinical trials and a majority of them who are enrolled in such studies receive nephrectomy instead of upfront immunotherapy-based approaches that would yield an equally favorable benefit. The editors look forward to exploring new results on this and other critical issues.

     On behalf of Kidney Cancer Journal and its Board of Editors, I wish you a new year filled with an improved outlook for your patients as we integrate knowledge gained from symposia such as the IKCS and look forward to clinical applications.

 

Ulka Vaishampayan, MD

Guest Editor

Chair, Division of Soilid Tumor Oncology

Director of Phase 1 Therapeutics

Karmanos Cancer Institute

Charles Martin Endowed Chair,
    Professor of Oncology

Wayne State University, Detroit, Michigan

 

The Official Journal of the Kidney Cancer Association

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Vol 17, No 3    2019