 All right, excellent. Well, I'm excited to be here. So welcome to the 2016 Kidney Cancer Association Patient and Survivor Conference. This is our second annual conference, and we hope to continue on an annual basis sponsored by the Kidney Cancer Association and hosted of course by our group here, Seattle Cancer Care Alliance, CW Medicine and Fred Hutch. I know I see a lot of familiar faces in the audience, but for those who don't know me, I'm Scott Tycote. I'm an associate professor here in medical oncology. I'm a clinician. I see kidney cancer patients and melanoma patients in our clinic over at SCCA. I'm our medical director for the Kidney Cancer Program, and I'll be introducing in a moment, Carrie Konoski, coming to us from the KCA, and she is the co-CEO. As we get started, just to make a comment, I don't know if people are familiar with our building, but if you need to take a restroom break outside into the hallway, take a left. When you see the entry desk, take a left. You'll find closest restrooms. We'll have a break mid-morning, a lunch break during the day as well. So good. I wanted to introduce our program today and just a few comments as we go along. And so the first slide here, just an overview of what's the burden of kidney cancer in the U.S. This is American Cancer Society data for 2016. And so men in the audience have a diagnosis of kidney cancer. How common is that? How many people are just like you facing kidney cancer? An estimate of nearly 63,000 new diagnoses in 2016 with 14,000 deaths from kidney cancer. And showing the incidents for men and women ranking by the most common diseases, 5% of American men, 5% of all cancer diagnoses, kidney cancer, the 7th most common, 3% for women, the 10th most common diagnosis for the U.S. So our first topic this morning I think really addresses the question I'm often asked as I meet new patients which is why did this happen? Why me? Why did I get kidney cancer? And we often don't have an exact answer for that, but we do know there are some risk factors and associations. Kidney cancer is an age-associated cancer like so many carcinomas. Very rare in pediatric and adolescent populations. It increases with advancing age, median age of diagnosis 64. There's a male predominance for kidney cancer about two to one and that cuts across pretty much all ethnic groups. There is an association with some modifiable risk factors smoking, obesity, hypertension. So we can find one of those features in about half of all of our kidney cancer patients. There's associations with less common things, environmental exposures, industrial agents, organic solvents, heavy metals, asbestos. Some disease associations that are less common. Patients with long-term kidney dysfunction, cystic changes in their kidneys, dialysis dependent, seem to be at higher risk for kidney tumors. Chronic hepatitis, sickle cell anemia have some association with kidney cancer. In certain drugs, long-term high dose use of analgesics finacetiner aspirin and perhaps prior cytotoxic chemotherapy exposure. But the first talk really looks at patients that have a genetic risk for kidney cancer, a hereditary component for their disease. So we're very happy to have Dr. Fuki Hisama, a professor in our division of medical genetics and the medical director of our UW genetic medicine clinic talking today with the title of her talk, genetics of kidney cancer. So after Dr. Hisama, we're going to take a look at surgical management of kidney cancer. So a figure here just to remind you kidney cancer fundamentally is starting in the kidney. Kidney tumor cells look the most like renal epithelial cells, the lining cells of the tubules in the kidney, the business portion of the kidney. And like any cancer, there's a staging algorithm for kidney cancer stage one, two, three and four, which tells us something about the extent of growth and the prognosis, the risk of that tumor. You can see their size criteria for placing tumors into stage one or two. Stage three implies impingement on other structures within the kidney, blood vessels getting outside of the kidney membrane. And stage four implies the spread beyond the kidney, so the distance sites in the body. Stage one, two and three localized tumors only in the kidney, not elsewhere in the body, are almost always going to be referred for surgical management. And what about our stage four patients? You have the spread of cancer at diagnosis is their role for surgery. This is a figure that just shows you what's the distribution of new diagnosis, how do patients present with kidney cancer. So this is from a large group of patients, a 12-year interval coming from a database that is incorporating data from over 1600 US hospitals, over 400,000 patients. So really giving you, I think, a very nice statistical snapshot of how do patients present contemporarily with kidney cancer. So stage one tumors far and away, the most common diagnosis, half of patients. Stage two and three, again, the solid majority of patients have a localized tumor. Stage four, about 16% of patients at first diagnosis. And this is a figure coming from a group in Boston, Tony Schwiery's group, Mass General and Dana-Farber program. Trying to look at the issue is, is there a role, a therapeutic role for doing nephrectomy surgery in the setting of metastatic disease? And so this is a survival figure. And we'll have these again. So to get you up to speed on what we're looking at, at time zero, all the patients are alive. And as you move through time on the x-axis, some patients are dying of their disease. And so the line is telling you what proportion of your population is still alive. So you want your line to stay very high near the top of the graph, meaning patients are still alive and surviving their disease. Bad is moving down near the bottom. And at the very bottom would be zero patients still living. And so you'd like to be in a patient cohort. That is the line that's running higher in the graph, not lower. The red line, that's the better line are patients that had an nephrectomy surgery, despite a diagnosis of metastatic kidney cancer. The black line are patients that did not have nephrectomy. And these are all patients that are moving forward on state-of-the-art targeted therapy for their kidney cancer. So do you move directly to medical therapy and skip the surgery? Or do you still have the surgery? And then as you recover, move on to therapy. As best we can tell, we think there's a therapeutic role and a benefit to having surgery, even in the setting of stage four of metastatic disease. So the point being, virtually all of our patients, there's going to be a thought and discussion about getting in to see a surgeon. So front and center in our clinical management is surgical therapy. And we're very happy to have Dr. John Gore. I bet some of you here know him personally as your surgeon. He's an associate professor in our Department of Urology. And he'll be talking to us this morning about contemporary surgical management of localized and metastatic kidney cancer. After Dr. Gore, we'll take a short break and we'll come back and I'll talk to you for an interval about medical therapies for kidney cancer. And just as a brief introduction, I have a timeline that shows you all of, by time points, the medical therapies that we currently use for kidney cancer. And it goes back to 1986 with really the first drug that we still use to some extent in kidney cancer interferon alpha. Before that time, there were no effective therapies that have been proven to have benefit in kidney cancer. For a long interval, we used interferon and interleukin two drugs called cytokine therapy. So for 20 years, that was state of the art for kidney cancer. The world changed dramatically in 2005 with the first introduction of what are called targeted therapies, primarily oral agents that are now commonly used for all of our patients with kidney cancer. And the seraphon of drug was followed rapidly by several other drugs in the same general drug family. And the world has changed again just recently. And this is what we'll look at in some detail. November 2015, the first FDA approval of a brand new drug class, what's called an immune checkpoint blocking antibody, nevolumab or Avdevo. Some of you here are probably actually receiving that drug. Great interest in the field. And we'll see a little bit really is going to drive, I think, clinical development and be front and center in what's happening for kidney cancer for the foreseeable future. So I'll be talking with the title new and emergent systemic treatment options for metastatic kidney cancer. Then we'll move forward and take a look at radiation based therapy for kidney cancer. This little schematic that shows you the common destinations for spread of kidney cancer when it's stage four, when it's moved beyond the kidney, the most common organ of spread, the chest, so lungs or medistinal lymph nodes, other common destinations, liver and adrenal, bony lesions and 30 to 40% or more kidney cancer patients. Brain involvement is fortunately less common for kidney cancer than other diseases, but 10 or 15% of patients will have brain involvement. So depending on the destination of the metastatic lesion, for some sites, we absolutely need the assistance of our radiation oncology colleagues. Brain lesions will almost always be approached with radiation based therapy. Bony lesions often cause chronic pain and our common target for radiation therapy, sometimes large bulk lesions and pinging on lung function or abdominal organ function or excellent targets as well. So we're pleased to have Dr. Jing Zhang that's here with us today, an assistant professor in our department of radiation oncology that will be talking to us with the title updates and radiation therapy for kidney cancer. At the end of the morning session, we're going to have Linda Kasser, registered dietician in our SCCA clinic. A question I'm often asked in the clinic when I meet patients is, okay, I have this diagnosis and we're talking about these, these drugs and the therapy is going to be applied. But what can I do in my own life? My daily routine? Should I change my diet? Should I do something different? Should I start on supplements? What can I control that's going to influence the course of cancer and what happens to me? So Linda's going to try and take this on and talk to you a little bit with the talk titled inflammation cancer and diet. I would ask our morning speakers at the end of the morning session, depending on where we are time wise, if we could all spend a moment to come down front and we'd be happy to field questions before we break for lunch. We'll come back and reconvene for the afternoon session. And Dr. Kim Musinski, she's covering the hospital service so she'll be along later on today is going to address another question I'm commonly asked in the clinic that I'm probably not the best person to answer. Most of our patients have had an effectiveness surgery. They have one kidney. We're often looking at our lab panel and the marker of kidney function is somewhat abnormal, the cratine value. So what are the implications of that? What's going to happen over time? If kidney functions abnormal if you're functioning with only a solitary kidney. So Dr. Musinski is going to talk to us about assessing kidney function. How much do you really need? And then we'll wrap up the afternoon session with Art and Julie Chimura. They are the local coordinators for our Seattle Kidney Cancer Association support group and giving us a few comments on their perspectives as both a kidney cancer patient and caregiver.