Mohammed Haseebuddin, MD, a fellow in Urologic Oncology at Fox Chase Cancer Center, discuses why continued research into immunotherapy in clear cell renal cell carcinoma (RCC) is important, particularly in the adjuvant and neoadjuvant settings.

There is a significant need for checkpoint inhibitors right now in terms of adjuvant trials in localized kidney cancer, he said. None of the targeted agents have really shown any decreases in recurrence-free survival.

Previous data showed that PD-1 levels are highest before surgery and then decrease after surgery. If that really is true, those who may benefit from this therapy who have high levels of PD-1 could potentially be identified and treated neoadjuvantly with immunotherapy, even before the tumor is taken out.

This could decrease recurrences and improve recurrence-free survival. There are currently several clinical trials out of Johns Hopkins Medicine and Dana-Farber Cancer Center investigating this.  

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Dr. Mohammed Haseebuddin on Expanding Role for Immunotherapy in RCC

Mohammed Haseebuddin, MD, a fellow in Urologic Oncology at Fox Chase Cancer Center, discusses the role of PD-1 expression in clear cell renal cell carcinoma (RCC).

An analysis looked at about 68 patients with clear cell RCC with flow cytometry and coordinated that with survival. These patients were compared with healthy non-cancer patients.

The analysis found that PD-1 expression on classical monocytes does demonstrate a poor prognosis—independent of grade, stage and other clinical variables, said Haseebuddin.

It has been shown, in the past, that PD-1 expression does decrease after surgery. The correlation that the analysis found between PD-1 expression and survival was in the preoperative setting, said Haseebuddin. If it can be determined which patients may have poor prognostic indicators, even before surgery, it is perhaps possible to identify those who would be better treated with immunotherapy.    

Dr. Mohammed Haseebuddin on PD-1 Expression in RCC

Mohammed Haseebuddin, MD, a fellow in Urologic Oncology at Fox Chase Cancer Center, discusses the overall significance of a study examining an elevated preoperative classical monocyte PD-1 mean fluorescence intensity level in patients with clear cell renal cell carcinoma (RCC).

There are 3 different types of monocytes, Haseebuddin explains, which are classical, intermediate, and non-classical. It is thought that the classical monocytes resemble proinflammatory monocytes, which then enter the tissue and act against cancer. All 3 of these monocytes play a role, he adds.

Regarding this study, researchers believed that PD-1 expression in select patient populations affects survival, leading to the idea that if monocytes seem to play a central role in the immune system, then perhaps PD-1 expression on monocytes are important for survival.

Mohammed Haseebuddin, MD, a fellow in Urologic Oncology at Fox Chase Cancer Center, discusses the overall significance of a study examining an elevated preoperative classical monocyte PD-1 mean fluorescence intensity level in patients with clear cell renal cell carcinoma.

Mohammed Haseebuddin, MD

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Dr. Mohammed Haseebuddin on Expanding Role for Immunotherapy in RCC

Dr. Mohammed Haseebuddin on PD-1 Expression in RCC

Dr. Haseebuddin on PD-1 Expression on Monocytes in RCC