Prof. Bernard Escudier, MD: Advancements in Kidney Cancer

Prof. Bernard Escudier, MD discusses the major advances in kidney cancer over the past several years as well as his research on the AXIS Trial. In addition, Prof. Escudier discusses the signs of kidney cancer, risk factors and questions you should ask your doctor.

The Group Room at the 2011 European Multidisciplinary Cancer Conference was made possible, in part, by:

 

VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel at the Multidisciplinary Cancer Congress 2011 in Stockholm. I’m very pleased to have you join us at Stockholm, Doctor Bernard Escudier from the Institute of Gustave Roussy in Paris, France. Your area of interest is kidney cancer, and renal cancer patients can feel isolated it’s a difficult disease. We don’t hear about it and talk about it as much as some of the other cancers. I’d like to talk to you a little bit about some of the treatment options for these cancer patients, also the biomarkers that are advancing in the diagnostic process that really makes a difference in how we treat this disease.

Prof. Bernard Escudier, MD, French Group of Immunotherapy, Institute Gustave Roussy, Paris:

Yes, I think first of all of course kidney cancer remains a very difficult disease to cure but in the same time in the past five to six years six new drugs have been approved. And it does really change the outcome of the patients which came from minimum of survival of twelve months to almost thirteen months. So it’s a big improvement. Despite that we still have a lot to do for our patients, first of all by new drugs. And we have new drugs coming, the last one being Axitinib, which has been reported recently as improving progression free survival better than classical drug which is sorafenib, so it’s going to be our next drug in the kidney cancer, and it’s a very active drug. And that’s a new hope for our patients, some new are coming out also. So certainly something which is of interest here.

And the second thing is that we are moving forward in kidney cancer to find biomarkers and that’s something that we are behind many tumor types.  We are still missing biomarkers and in this meeting for example, we describe in this study all of some snips pertains to defining particle activity of this target. And it’s interesting to see that some genes seem to be able to determine which patients is a good candidates to receive the drug. So the big news here is that it’s not only just a tumor it’s not just a disease but each patient probably has put in mind to better respond to one drug or to another one. And at the end for treatment of cancer in general I think we have to put together some biomarkers into the tumor, some clinical characteristics and at the end, you, as a host who is going to receive the drug because probably depending on your genes you will have more difficulty or more efficacy with one drug or another one, and that’s a big change.

Selma Schimmel:

And could you elaborate a little bit about how biomarkers influence the treatment decision process.

Prof. Bernard Escudier:

If you ask me this question in general cancer, I can say a lot. In kidney cancer so far it’s just the beginning so we’re hoping to find the equivalent of ALK, for example for lung cancer or for two for breast cancer. We don’t have this biomarker so far so we just have genotyping, which start to help us, and we start to have something into the tumor but we don’t have the equivalent of the best biomarkers, as we don’t even know what this is.

Selma Schimmel:

So where are we at right now with current treatment? And where do we hope to go as we progress with treatment options?

Prof. Bernard Escudier:

So what we are today is we’ve at least two big categories which are actives. One category targeting VEGF.  We are moving from weaker drugs to stronger drugs, and more active drugs because they are more selective, and Axitinib being one of these new drugs. And second generation, second kind of drug is what we call mTOR inhibitors and we have started with two mTOR inhibitors and one moving part in the future to hold the mTOR inhibitors because that’s something which is really moving for our patients. And the second thing is that we are starting to find out with all this luck we have how we can select the good drug for the good patient. And that’s what is coming with this genotyping of the patient.

Selma Schimmel:

This is the essence of the current research.

Prof. Bernard Escudier:

Absolutely.

Selma Schimmel:

So what does today’s kidney cancer patient viewing this video – they’re about to go to their doctor, they’ve been diagnosed – what are the questions they need to ask their doctor?

Prof. Bernard Escudier:

Things that they need to ask: do you have any idea of why you should give me such a drug or such drug. I think there is something that’s coming and do you think I need genotyping to help you to select the good drug, and I think if they do that they won’t be long in a few months from now, it’s coming.

Selma Schimmel:

Are there any genetic predisposition? Are there any risk factors that patient should know about that might make them more susceptible to a diagnosis of kidney cancer?

Prof. Bernard Escudier:

Yes, there are some. So last year it has been reported that in localized tumor we have a series of 16 genes which might help to predict a patient’s fate. This year it was reported that in the patients which makes the patients more likely to occur, so it means that the way you are going to survey your patients to city-scan your patients on a regular basis by change based on genetics. So it’s going to be important for everyone to know that if you have a good gene – I don’t know if it’s good – but at least you have your risk factor is very low; if you have no gene it’s higher so you will have to be monitored more frequently.

Selma Schimmel:

If one has a family member with kidney cancer, are they more susceptible to developing kidney cancer as well?

Prof. Bernard Escudier:

The answer is no in 95% of the patients. I mean the genetic risk in terms of transmission of this risk is actually very limited and it’s a very small number of patients.

Selma Schimmel:

Is there an average age where one might be diagnosed?

Prof. Bernard Escudier:

 Yeah, it’s changing but age is almost about 60, something like that. So the age was the measure of the patient; sometimes younger, sometimes… but median age is 60.

Selma Schimmel:

And what about gender – male, female? Is there more incidents in either?

Prof. Bernard Escudier:

Fortunately it’s better for you, more males than female.

Selma Schimmel:

And the other understanding I have is there is environmental risk factor, exposure.

Prof. Bernard Escudier:

Yeah, tobacco is one of its factor as some chemical product seems to be exposure to some big chemical products maybe, obesity and hypertension is also.

Selma Schimmel:

And lastly, when one goes to their general doctor for their regular checkups, are there any tests or should they be talking to their doctor about some kind of a screening or examination to be sure that their kidneys are healthy?

Prof. Bernard Escudier:

Actually it’s not in practice to do screening for kidney cancer because it’s not that high as prostate or breast. But I think everyone should know that in doing at least an ultrasound when you start to be 50 just to check that your kidney are okay make sense, although it’s not yet recommended by the society. I think it should be fair to do 65 years, something like that.

Selma Schimmel:

Patients who are diagnosed with kidney cancer, do they tend to be diagnosed later with a more advanced disease?

Prof. Bernard Escudier:

No, it’s becoming earlier because of a lot of imaging in general for anything. I mean lot of kidney cancer is good for them incidental kidney cancer.

Selma Schimmel:

So what is your final  message you want to share with the kidney cancer patients, in addition to the fact that the future will hold, hopefully, biomarkers that will be able to tailor their therapy?

Prof. Bernard Escudier:

My final message is that survival has increased a lot in the last five years and it’s still increasing. I think every year we have the feelings will increase by almost six months of survival, and hopefully, I mean at one point we’ll know better which target to use and finally I hope we cure the patients.

Selma Schimmel:

Thank you Doctor Bernard Escudier, from the Institute Gustave Roussy in Paris, France. And especially thank you for doing work in an area that doesn’t get as much discussion as some of the other cancers.

Prof. Bernard Escudier:

Thank you very much.

Selma Schimmel:

It’s been a pleasure.

END OF VIDEO.

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