FASTRACK II

“Surgery is the standard of care for primary RCC, however older patients might have co-morbidities that may exclude them from this option,” stated radiotherapist Dr. Anna Bruynzeel (NL) in her presentation on the methodology and results of the non-randomised FASTRACK II trial (Focal Ablation Stereotactic Radiotherapy for Cancers of the Kidney). “The aim of the study was to investigate the efficacy of SABR as a treatment option for renal cancer patients who are unwilling or unfit to undergo surgery. This group of RCC patients who are medically inoperable with larger tumours, have limited curative treatment options and need an effective alternative.”

According to Dr. Bruynzeel, SABR is a precise, high-dose radiation treatment targeting tumours with minimal impact on surrounding tissue and the FASTRACK I study concluded this method for primary RCC was feasible and well tolerated. “These findings have been used for the design on this next phase 2 trial.”

Dr. Bruynzeel on the study results: “The medium follow-up was 43 months. For the primary endpoint assessment, local control at 12 months from start of treatment was 100%. There were no local failures observed during the trial. Freedom from distant failure was 97%. Cancer specific survival was also 100%. Overall survival was 99% at 12 months, and 82% at 36 months from the start of treatment.”

“The excellent oncological outcomes after SABR for primary RCC observed in this trial are concordant with those reported in the prospective and retrospective literature. SABR can be considered a proven modality in this group of patients with larger tumours.”

According to Dr. Bruynzeel, the next step is now randomised trial surgery versus SABR. She also concluded her presentation with some remarks to consider: “In comparison to prospective trials of surgery, FASTRACK II has a smaller sample size and less mature follow-up. The study did not have a control group, so it was not possible to access whether SABR is superior, inferior, or similar to other treatment options. Definitions of operability or technically high risk might vary between multidisciplinary teams.”

KEYNOTE 564 OS

Urologist Prof. Jens Bedke (DE) shared the study design and results of KEYNOTE-564 OS that was presented earlier this year at ASCO GU 2024, that indicated this phase 3 trial showed improved overall survival with an adjuvant therapy among patients with clear-cell-renal carcinoma who were at risk of disease reoccurrence after nephrectomy. In his summary, Prof. Bedke stated that pembrolizumab is the first adjuvant treatment in RCC with an improvement in overall survival (OS). In his opinion, there is risk of overtreatment and risk of life-long treatment related adverse events (e.g. life-long toxicities, and life-long L-Thyroxin). “Failure of CheckMate 914, Immotion010 and PROSPER with drugs active in the metastatic setting (nivolumab plus ipilimumab, nivolumab and atezolizumab) raises questions about patient selection and conduct of trials. Better selection criteria using a hybrid of pathological risk, somatic driver mutations and molecular subtypes are required beyond PD-L1 and sarcomatoid features and dosage. New therapy approaches such as mRNA vaccination plus ICI trials are recruiting.”

You can watch a webcast recording of the full RCC Plenary Session on the EMUC24 Resource Centre.

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Dr. Salvatore La Rosa (US), Chief Scientific Officer of the KCA is enthusiastic about their contribution to the EMUC24 programme: “As a non-profit advocacy organisation, we are thrilled to collaborate with EMUC this year to deliver cutting-edge research summaries and valuable kidney cancer education to attendees. Our aim is to empower clinicians with the knowledge and tools they need to provide the highest quality care for their patients.”

“In today’s digital age, patients and their families have access to vast amounts of information online about their diagnoses. However, it’s crucial that they receive accessible, evidence-based, and up-to-date information about kidney cancer to make informed decisions and advocate for their options. We hope to reach more health professionals with information that can be passed on to their patients, ultimately helping them to navigate their cancer journey with confidence.”

“For KCA, whose mission is to find a cure for kidney cancer, this collaboration is a unique opportunity to bring together experts from various specialties to address the latest topics and challenges in renal cancer. This is particularly significant with urologists, who are often not as involved in kidney cancer patient care as they should. By leveraging the EMUC platform, we also aim to draw more attention from other specialists to kidney cancer and attract them to the field by presenting them with the unique challenges our patients face at every step of their journey.”

What’s on the agenda?

The first KCA plenary session will take place on Friday 8 November from 16:15 till 17:30 and will feature presentations on several key practice-changing studies, including trial results from FASTRACK, KEYNOTE 564 OS, and SUNNiFORCAST. There will also be a debate on evidence for local tumour control in metastatic RCC with a review of current retrospective data and ongoing phase II and III trials in this setting. For cytoreductive nephrectomy, urologist Dr. Géraldine Pignot (FR) will present on PROBE and NORDICSUN, and for radiation oncologist, Dr. Anna Bruynzeel (NL) will present on stereotactic ablative body radiotherapy (SABR).

Experience a WoodFire® session

The second KCA Plenary Session will take place on Saturday 9 November from 11:40 till 12:45 and will introduce a unique format to the EMUC24 programme called a WoodFire® session.

Dr. La Rosa explains: “This is essentially a live tumour board. It got its name due to the quick-fire, high-pressure nature of how our late Board of Directors Chair, Dr. Christopher G. Wood, a renowned surgeon at MD Anderson Cancer Center in Houston, Texas, grilled his peers about how they might treat someone with kidney cancer – all in good fun! It is fascinating to hear how differently a surgeon might approach a single case versus a medical oncologist versus a urologist, and so on. WoodFire® is both a glimpse at how much we must learn from each other and a testament to how much everyone cares about achieving a good outcome for the patient.”

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The 16th European Multidisciplinary Congress on Urological Cancers (EMUC24) is set to take place in Lisbon, Portugal from 7-10 November 2024. Each year the congress brings together leading experts across various genitourinary cancer disciplines to share their insights on best practices, key clinical trial developments, and the latest scientific advancements. You can view the full EMUC24 scientific programme and take advantage of registration savings if you sign up before 24 October, 2024 (23:59 CEST).

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