In this exclusive ASCO podcast, Andrew J. Armstrong, MD, ScM, Assistant Professor of Medicine and Surgery Duke Comprehensive Cancer Center, Departments of Medicine and Surgery, Divisions of Medical Oncology and Urology, addressed the vexing clinical issue of chemotherapy's limited effectiveness in advanced renal cell carcinoma, and the subsequent increase in targeted therapies as a first-line option to treat unresectable kidney cancers.
"Kidney cancer is a different disease than other solid tumors in that it does not traditionally respond well to chemotherapy. Immunotherapy has also played a role in kidney cancer, again without much success," said Dr. Armstrong.
Are we finding a clearer pathway for treatment in this difficult clinical scenario?
"Over the past 5 years," Dr. Armstrong commented, "We've had six new targeted molecular therapies approved for use in advanced or metastatic kidney cancer, which is more than any other solid tumor types, so the drug pipeline in this disease is actually quite promising. The original targets were the VEGF receptors starting with the approval of sorafenib(Drug information on sorafenib) (Nexavar) and sunitinib (Sutent). The next set of approvals focused more on the mTOR inhibitors."
Dr. Armstrong also discussed his lead role in an important randomized phase II study in patients with metastatic non-clear cell renal carcinoma. "Our trial is called the ASPEN study, in which we will compare the anti-tumor activity of everolimus and sunitinib in patients with metastatic renal cell carcinoma with non-clear cell pathology. We've really never had a controlled study in which evidence has been used to make a decision to inform clinical practice," said Dr. Armstrong.