Characterizing Biomarkers of Growth and Progression in Small Renal Masses (SRMs)
Abstract
The majority of kidney cancers are diagnosed as an unexpected finding on a scan as small kidney tumours before they cause any symptoms. For many years, the standard treatment for these small tumours was to proceed to immediate surgery to remove either whole or part of the affected kidney. Although this approach is associated with a high rate of cure, it is now recognised that most of these small cancers are slow growing and unlikely to spread. This has led to concerns that we are overtreating many patients, in particular, those with a limited life expectancy (due to complex health problems and/or advanced years) in whom the risks of surgery are greater. An alternative to immediate surgery is active surveillance, where kidney tumours are carefully monitored with repeat scans over time. In the event of significant tumour growth, patients are advised to have a procedure to remove the tumour. The available studies of active surveillance have shown that most tumours grow very slowly with only 1 in 3 patients requiring delayed surgery although there is a small risk of tumour spread outside of the kidney to distant parts of the body on active surveillance of approximately 1%-2% (1-2 cases with cancer spread for every 100 patients on surveillance). There are no tools that can reliably predict tumours that are born to be bad, and are likely to grow or spread, from the slow-growing tumours that are unlikely to cause harm or reduce life expectancy. Such a tool could help doctors and their patients decide whether they could avoid surgery and opt for active surveillance. In this study we will analyse samples from two studies, one a group of over 800 patients that had surgery for a kidney tumour in the past and the other a group of patients enrolled in the European Active Surveillance of Renal Cell Carcinoma Study (EASE RCC Study) that are having their kidney cancer monitored by active surveillance following a biopsy (sample) of the tumour being taken to confirm the diagnosis. Part of the biopsy sample will be sent to the Francis Crick Institute in London for researchers to study and try to develop tools to identify the born to be bad cancers. Participants in the study also agree to provide blood and urine samples at the start of the study and on a number of other study visits to coincide with their surveillance scans during follow-up. They will also have their scans reviewed by specialist researchers to see if the laboratory tests can be predicted using normal CT scans, which might remove the need for biopsy in the future. Projected Time to Achieve Outcome: The discovery cohort has been recruited in advance of this study, meaning that we can analyse all the samples and scans from these patients as soon as the funding period begins. Recruitment to the EASE study will be over the next 2-3 years. We will complete all the tumour profiling of biopsies and scans. We will monitor patient tumour growth for at least 2 years to assess how useful our test is for predicting tumour behaviour on surveillance. How does this advance the field of kidney cancer research? Our vision is that the additional profiling of these patient samples will predict which patients are high risk for tumour growth or spread that are unsuitable for active surveillance and should proceed to immediate surgery or ablation. In addition, we hope to develop tests with the blood and urine specimens collected during surveillance that can be used as tools to monitor tumours on active surveillance and predict when tumours are starting to grow or spread. These tools would allow doctors to individualise patient care and to counsel their patients about the competing risks of active surveillance versus immediate surgery, allowing them to make an informed choice about the most suitable management strategy.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210652
Entities
People
- Samra Turajlic
Organizations
- Francis Crick Institute
- United States Army