Alison Fielding was delighted to be invited to the 13th European International Kidney Cancer Symposium 2018 in Prague on 27-28th April, where she talked about kidney cancer services from a patient’s perspective. You can take a look at Alison’s presentation here: A Patient View Here is Alison’s report on the meeting:
After 4 years of living with kidney cancer and reading about research going on worldwide, it was great to be in a room where so many authors of the papers were all in one place. For 2 days, the great names and rising stars of urology, oncology and science sat together to learn from each other and debate issues.
From stunningly impressive science looking into how kidney cancer develops from the TRACERx Renal team, revelations about the effect of our gut bacteria, the impact of antibiotics on treatment, to emerging information from trials and case studies, layer by layer we learnt more about kidney cancer and ways to diagnose and treat it. We also learnt just how much is still unknown. We don’t truly understand who will get kidney cancer and why; we don’t know which treatments will work for each patient; we don’t know how drugs may be developed to attack processes essential to disease growth; and we don’t know the impact that future treatments will have on patients in terms of efficacy or side effects.
The slides and many videos of the presentations will be online soon so rather than summarise them, here are my personal highlights.
- The recent TRACERx research on the science of renal cancer development was presented by the project leader, Samra Turajlic, consultant medical oncologist from the Royal Marsden Hospital. Even though you’ll need more than ‘O’ Level/GCSE biology to grasp it all, it is worth taking a look at her presentation. KCSN have asked her to help us do a patient-friendly version.
- I loved the presentation on the impact of the microbiome on immunotherapy response. PhD student, Lisa de Rosa from France, has a bank of faeces samples, which she has analysed. She demonstrated that the presence of certain bacteria predicts the response to treatment and lays the groundwork for ways to change the patient’s gut bacteria to improve their chances of a response. See Lisa’s presentation here.
- The use of screening for kidney cancer in appropriate cases was presented by Dr Grant Stewart, consultant urological surgeon, Addenbrooke’s Hospital, Cambridge. See Dr Stewart’s presentation here.
- Once identified, Dr Maxine Tran, consultant urologist, Royal Free Hospital, London, made the case for more biopsy use to avoid over treatment of benign masses and the risks associated with this. See Dr Tran’s presentation here.
- As you would expect, there were lots of presentations about immunotherapy. There are too many to list but the focus was on its use in both metastatic settings and in trying to prevent disease recurrence. The important points in all the immunotherapy discussions was the relatively low response rate, the risk of side effects, increasing results for the time before disease progresses, and the potential for durable responses in the lucky few. Overall survival is usually just as important as time before progression for patients. It was clear that it is difficult to assess how survival, having had immunotherapy and then moving on to another treatment, may be impacted positively by the immunotherapy, even if immunotherapy had appeared to fail.
- Whilst immunotherapy grabs all the news headlines, it was clear that there is still a place for tyrosine kinase inhibitors (TKIs). Indeed more will be developed, which work in slightly different ways. Combination therapy of different TKIs with immunotherapy seems set to dominate clinical trials for years to come.
- Drug treatment when you don’t have any evidence of disease, but hope that treatment will stop progression in future, is called adjuvant therapy. There are conflicting views in the cancer community about whether it works, with the balance currently falling on the ‘it doesn’t work’ side, at least for TKIs. Professor Tim Eisen, Cambridge University, presented his research with patients, which asked them how much extra life they would want to justify putting themselves through treatment. Watch here and see if you agree with the results.
- There were lots of case studies. My vote for the doctor that I would most like to be my doctor was Daniel Heng from Toronto, Canada, who always included details about the patient as a person and not just a biological challenge, and whose choice of treatment was matched to the patient’s life goals.
- Half the audience were women and, although a much smaller proportion of presenters were women, they are making their mark and will be the leaders of the future. It shouldn’t be a surprise, but I normally attend cardiology events where women on stage are rare.
- On a similar note, I was proud to be British and be there to see the presentations from the leading clinicians and scientists in Europe – 22% of presenters were from the UK. There may be things about our healthcare that we would like to improve but when it comes down to it, you know you are in the best hands. I was also proud of myself because they posed questions at each session and I got them right. That is more of a credit to the KCSN in that I was an informed patient before I went thanks to their great information services.
Just like a consultation I, as a patient, was given 10 minutes at the end once the doctors had finished! Following on from 2 clinicians who had done a good job of outlining the benefits of centralised services, I talked about some of the challenges to be overcome to make it better for patients. For this, I spoke about the wider experience of having cancer and being a carer, and the difficulties which we can face when treatment is away from home, such as travel time and effort, costs, and isolation from key services just as you need them. I hope that some will follow my 5 point template for making it a success.