(UroToday.com) Following the proffered paper presentations from Dr. Maxime Meylan and Dr. Zeynep Zengin looking at predictive markers in advanced kidney cancer, Dr. Walter Berger provided an invited discussion of these data.
He began by highlighting the current circumstances of precision therapy in renal cell carcinoma – despite tremendous benefits from targeted therapy and immune checkpoint inhibitors, there are no established biomarker-driven approaches in this disease. Thus, there is a huge unmet need.
First, assessing the data from Dr. Meylan, Dr. Berger highlighted that cancer is an immunological disease. Thus, considering the immune milieu and tumor microenvironment is important as a biomarker for immunotherapy response. Based on the similarity between the NIVOREN cohort and the CheckMate 025 cohort, Dr. Berger emphasized that these data are reliable. Dr. Berger wondered why the Angiogenesis component of the validated T-effector/Angiogenesis signature was predictive of response to the immune checkpoint inhibitor nivolumab.
Moving beyond validation of the validated T-effector/Angiogenesis signature, Dr. Meylan’s group derived their KIC score based on MCP-counter abundance scores. Notably, in this analysis, patients with immune-high and stromal-low signatures had the best response to immunotherapy. Interestingly, the authors showed little concordance to the signature from IMmotion150. He concluded by suggesting that these data are too early to the impact of treatment decisions and, further, wondered whether such genome-wide analysis was feasible in routine clinical practice.
Moving to the second abstract assessing liquid biopsy using ctDNA, Dr. Berger began with a conceptual overview of pros and cons of liquid biopsy, including the potential for sequential assessment. Discussing their concordance analysis, Dr. Berger expressed surprise that there was such little similarity in the detection of genetic alterations in ctDNA and in tumor-tissue. This may be due to time elapsed between these tests. As a result of these data, Dr. Berger wondered why there were such differences between testing approaches, including the contributions of biology, tumor heterogeneity, and different sequencing platforms.
Presenter: Walter Berger, Medical University of Vienna, Vienna, Austria
Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN, Twitter: @WallisCJD, at the 2020 European Society for Medical Oncology Virtual Congress (#ESMO20), September 19th-September 21st, 2020.