Predictive biomarkers for kidney cancer

At the Society of Urologic Oncology (SUO) conference in Washington, USA last week, Dr Joshua Lang discussed the future of predictive biomarkers in renal cell carcinoma (RCC).

The treatment of kidney cancer is evolving with first-line combination therapies, including nivolumab plus ipilimumab and axitinib plus pembrolizumab, and first-line drug options that depend on risk of disease, such as cabozantinib and pazopanib.

Biomarkers can be categorised as follows:

  • Diagnostic – identifies the presence of cancer (malignancy)
  • Prognostic – baseline patient or disease characteristics that give an indication of risk for disease recurrence/progression
  • Predictive – baseline characteristics that give an indication of response to a particular treatment
  • Pharmacodynamic – dynamic assessment showing a biological response has occurred after treatment with a particular drug
  • Discovery – biomarker that gives an indication of genetic changes that cause tumour growth, metastases and resistance to drug treatment
  • Surrogate – biomarker intended to substitute for a clinical efficacy endpoint.

Biomarkers will help doctors determine who will respond to drug treatment, why patients develop resistance to drug treatment, what the next/best treatment is, determine how to combine treatments, assess when resistance should be targeted, and help identify the next generation of drugs. In summary:

  • There is an urgent need for predictive biomarkers
  • Single tumour biopsies may not represent the heterogeneity of RCC
  • Liquid biopsies may capture the heterogeneity, but it remains to be determined how a single cell protein analysis correlates with primary or metastatic tumours
  • Single-cell phenotypic analysis shows early clinical correlations for immune checkpoint inhibitor and TKI therapies
  • But ultimately, can we do better than CT scans to identify emerging signs of resistance?

Read more in UroToday here

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