 Good good. Well, good morning everybody Excited to have such a big group this year So we're excited to kick off our 2017 kidney cancer Association sponsored patient Survivor conference This is our third year for doing a conference and with a plan that this would be an annual signature event for our program and our campus And so look for this late June early July Next year as it comes along So let me start off Beggars myself. I'm Scott Ticody many of you I know but for folks that that don't know me that haven't seen me in clinic. I'm a medical oncologist here at the University of Washington campus specializing in kidney cancer In Melendoma care on our campus and I'm our site director for kidney cancer research And so to start off our program today I want to introduce Kerry Koneski. We're very excited to have Kerry here She's the CEO for the kidney cancer Association, which is a national advocacy advocacy group for kidney cancer So I'm going to bring Kerry up to kick off the morning. Hi. Good morning everyone It's been so nice to meet all of you as you came in today as dr. Ticody said I'm Kerry Konozki I am the CEO of the kidney cancer Association Before I get started just telling you a little bit more about what we do I wanted to thank dr. Ticody again for putting this meeting on for us for his team and especially Samantha for all your help with outreach I know there's a lot of new faces here this year, which is exciting to see So just a little bit about the Association for those of you that are not familiar with what we do The kidney cancer Association was established in 1990 by a kidney cancer patient Jean Schoenfeld In 1990 we did not have anything for kidney cancer patients. There was no meetings like this There really wasn't any kind of internet or technology. So when dr. Schoenfeld was diagnosed he felt very alone he was a Professor at the Medill School of Journalism at Northwestern. So a very intelligent academic Gentlemen who thought well, there's gotta be something I can do about this So he got a message boards up on the internet before that was really a thing that people knew what to do with He worked with his doctor Dr. Nick Bogel saying who was in Chicago at the time and is now still treating patients out in Nevada And they sat around the kitchen table with a couple of their patients and thought what can we do? And so that was the start of the kidney cancer Association It was really about pushing to get some sort of treatment to get research to be done for kidney cancer advocating in DC You know trying to find a network of patients throughout throughout the US to see you know How many people were affected and what were the needs of patients? And so here we are 27 years later Which is hard to believe with so many therapies now for patients We've got a meeting with 90 people signed up for this meeting this year And it's only our third year here in Seattle and this is just one of about six meetings like this that we do throughout the US We work globally now. So instead of being just at a tiny kitchen table outside of Chicago We are now all over the world. I'm coming from Tampa We had been based in Chicago up until about four years ago when we realized we were growing really fast And globally and that being in one time zone in one office didn't really make a whole lot of sense anymore so we now have volunteers and Staff members and contractors that we work with all over the world with some of the top physicians Nurses and we have amazing board of directors who is very involved Many of them are patients and survivors or caregivers like yourself in addition to meetings like this We do smaller support group meetings In local communities art and Julie who some of you know may have spoken to already this morning They do a meeting about five times a year. Yes in the evenings where they will Vary the topics and they are fantastic about commuting cating So if you didn't sign up for their list out there, please do so now and we try to send out through our network as well When they're doing meetings if you're not local enough for that and are interested in doing something in your area You can contact me or go to the website and email the General office information and someone will get back to you to help you get something started We do medical symposia as well So we from the beginning with dr. Schoenfeld's model is it's always been extremely important to us to not only educate Patients and families about what's going on the disease but also to make sure that physicians Stay educated on what's going on in research So we do a meeting here in the u.s. Every fall and then we go to europe every spring For our global impact that meeting is for physicians only but we do put those videos online So you have access to the website and haven't been to our to the kidney cancer or website I would encourage you to do so and go to the video section and you can see More at a medical level, but it talks more about kind of what what's going on in research for for kidney cancer Right now. We also fund research Our projects are primarily young investigator awards. So knowing we've been around since 1990 We have been extremely fortunate that the doctors who were there from the beginning are still around and still working hard But they have realized that eventually they are not going to be be there and not be the ones sitting at the table And so they want to encourage the younger minds to keep focusing on this disease So that we don't lose all the amazing momentum that we have have had so we fund Two projects through larger institutions, and then we do two to three Grants directly through the kidney cancer association that are peer reviewed And then we help to advocate So if it's some you talking to us wanting to know you know information that you can pass along to insurance companies to help for Getting therapies approved. A lot of that is globally our advocacy work because A lot of other countries don't have to access the drugs that we do. So we spend a lot of time trying to work On that and our funding Comes a lot from the pharmaceutical industry So I do want to thank Pfizer for helping to support this meeting to make it possible for you I'll be here to put this meeting on video so that patients who are not able to be here with us today Are able to watch that and we rely on donations for patients and families So anytime if you want to give if you have friends and family that want to know how they can contribute You can always make a donation to our organization and let them know what we do that we provide education and we do research And then we also do we have a lot of people now who are interested in doing their own fundraiser So being a small disease it's sometimes hard to to do races and galas all over the world So we work with a lot of families who In their communities that want to start a race or want to join a run or Do an event in their town and if that's something you're interested in if you have family members Who again who want to do something to give back help raise awareness because you're the first person They've ever heard of that had kidney cancer. We can help you do that. Um, one thing I'm doing this year They'll be raising funds. I'm a runner and I'll be hitting my 12-year mark at the kca in august So my goal this year is to do a race every month 12 months for 12 years So, um, I'll be doing that and putting that out to to try to raise some funds this year and and see what We can do with that. So, um, I think that's my brief overview of the kca I will be here all day if you guys have any questions or want to talk a little bit more about some of the Specific work that we've been doing. There will be a lot of information coming at you today I'm sure so again, this will be videotaped and we will send an email out to let you know When that's online. So if you have questions So with that, I will turn it to dr. Tycote. Thank you all and enjoy the rest of your day Thank you. Carrie Okay, uh, so before I bring up the first speaker I just wanted to make a few comments to just kind of introduce an overview of today's program and some of the thoughts Going into the different talks That we have lined up for you So there is a printed program if you didn't pick one up right outside of the table you can grab the program So the morning session will have four speakers a short break There's restroom down the hallway when you go back towards the front door by the information desk Take a left and you'll find them And then we'll break for lunch before the lunch break. I would ask the morning speakers That are still able to stay if we can come up and just do a speaker panel and field questions And you know, we're here for you folks So as we go through the talks if you have questions, don't be bashful Each of the speakers is happy to take on a few questions after each talk But then we'll have a panel session as well And if you don't have questions, you're welcome to hit the lunch break a little bit early for that So just uh, you know an overview keeping cancers aware is it not rare What's the burden of disease in the u.s. I just like to look at American cancer society statistics About 64,000 new kidney cancer diagnosis annually in the u.s. 14,400 deaths And it's a male predominant disease about two to one male incidents versus females across ethnic groups So in men, it's the sixth most common cancer in the u.s. About five percent of new cancer diagnoses for women 3% so it's a top 10 cancer It's fairly prevalent, but you know doesn't rise to the level of breast or lung or colon And if you look at the stage distribution of kidney cancer, so this is a large group of patients I think gives you a good statistical feel for what's what the patients look like that get diagnosed with kidney cancer This is a large database that captures new cancer diagnoses from hospitals nationwide 1400 hospitals reporting cancer incidents 370,000 total cases and so You look at the breakdown the most common presentation of kidney cancer is a local tumor In a stage one tumor meaning less than seven centimeter in size. So smaller size Tumors in the kidney is the most common way that kidney cancer is going to present and be detected Stage two and stage three are still local tumors meaning it's a kidney mass. There's no evidence of cancer beyond the kidney But a larger tumor or tumor that's beginning to impinge on associated structures like blood vessels lymph nodes And then stage four patients that have clear cut metastatic disease at the time of diagnosis So only a minority of patients fall into that category when they're first detected with kidney cancer And the local tumor is by and large a disease that's going to be managed by by surgical therapy So the first talk by dr. Gore A urology surgeon here on campus associate professor at the university of washington Is entitled surveillance for localized kidney cancer. So speaking to the majority patients that are going to present with a local tumor And what's the current state of the art for managing those patients? And then i'll be speaking after dr. Gore and My topic my title new developments in adjuvant therapy for renal cell carcinoma So from the medical oncologist standpoint when I receive a patient from my urology colleagues, it's had an effect to me What do we bring to the table? Are there any therapies that are preventative that are prophylactic? Where do we stand? What's the new data that's emerging and then what's coming? What are we going to have as therapy options as investigational studies? coming down the road And then we'll have a short break and we'll come back and Dr. Frederick's We're presenting a talk on something called the microbiome. So What is the microbiome and why is that very? Timely and topical in the field We think of ourselves as as a single organism Single entity I'm sure we're all aware that we're made up of individual cells, but you probably don't really think about that on a daily basis But that's not all we are we are actually a community Of organisms all of us are colonized with with microbes that are part of our body part of our normal Flora, you can't get rid of them. They're always there And a couple little factoids here There are 10 to 100 trillion Individual microbes that are part of our body our skin surfaces our mouths upper air Airway tract But primarily the gut the gi tract and the lower bowel is of course not a sterile environment And has a tremendous content of of microbes as part of its normal biology There are 10 fold more individual microbes as part of us Then the cells that make up our body and so those numbers are fairly staggering There's about 10,000 different species of microbes on any of us as part of our normal flora And if you looked at the unique genes in those microbes, there's 100 fold more genes In the microbes that are part of us than the genes that make up our own body and so It's an intimate part of Of what we are and it's becoming increasingly clear That the microbial Flora that we have can influence health in a variety of ways And so this idea of what's the content of our Microbiological community that we live with and how is it affecting health is becoming An area of interest in a lot of different health arenas, but in cancer In the world now that we live in where immunotherapy drugs are becoming commonplace across cancers of all kinds Certainly in kidney cancer. How does this Part of our biology influence the success of those drugs? How does it react to cancer therapies apply that Might injure your guts change your flora? What about intentionally manipulating the process? What about probiotic therapy? What if you get antibiotics? It's becoming a very Timely issue. It's talked about widely at cancer meetings And so Dave Fredericks is an expert in this area has been working on the microbiome for many years And we'll give us some insight into how this area is going to impact how we think about cancer delivery and cancer therapy So dr. Fredericks May get here at hopefully a break time And so we'll talk about cancer in the human microbiome and give you a lot more detail and insight into where this field is going But I think incredibly timely For the immuno oncology world that we live in in the last couple of years And then the next two topics I think link together In a conceptual way as we're applying immunotherapy treatments to patients We know the success is very heterogeneous for some patients. It works great for other patients Not so much and for some patients doesn't seem to do anything useful at all And the question is can you manipulate the system? How could you make therapies work better? And so on the left panel here is a patient that's receiving an immunotherapy compound and it's doing nothing And so the the unresponsive or so-called cold tumors in blue And the issue that overlaps with a variety of different possible maneuvers is can you provide some kind of intervention locally To only part of the total tumor in a patient that's going to change the immunological appearance of the tumor make it more immune reactive And you'll get secondary effects at lesions that you haven't manipulated you haven't treated that are immune mediated So the immune system gets activated you create some kind of of autologous vaccine effect by manipulation you apply And that gives you a therapeutic effect that crosses over and recognizes multiple tumor lesions That could be radiation based therapy There's a brand new therapeutic for melanoma. That's an injectable Virus it's a modified human herpes virus called t-vac So injecting a virus creating inflammation killing some of the tumor at the site of injection but getting secondary effects at other lesions You could destroy a lesion with heat or freezing. So ablation technologies Thermal ablation cryoablation any of those modalities overlaps with this broader idea that can you manipulate immune responses create An onboard vaccine effect by treating a single lesion When this happens in the setting of radiation this term an abscopal response is commonly applied And so if you're on the internet you're looking around you're seeing references to abscopal responses That's what they're talking about particularly for radiation therapy treat a single lesion get secondary effects at other parts of the body So dr. Zhang an assistant professor at department of radiology will be speaking about advances in radiation therapy for kidney cancer And then after dr. Zhang speaks I would ask the morning speakers if you're available to stay we'll have a little panel Feel any questions folks have before the lunch break and then we'll come back and dr. George shade That's an assistant professor in the department of urology. We'll be giving a talk Entitled histotrypsy a novel ultrasound based treatment for kidney cancer So talking about that modality as local therapy, but also possible systemic consequences And then the last item for the day Changes tracked and and takes on another topic As we talked about a moment ago many patients with kidney cancer have a local Tumor that's going to be treated surgically So a surgical therapy to take out part or all of the kidney So a lot of patients start with surgical therapy because they have a local tumor Even in the setting of metastatic disease, this is a figure from a research paper That makes the argument that what's called cytoreductive surgery Taking out the primary tumor in the context of metastatic disease Has a therapeutic benefit and so this is showing you the survival Over time of patients that had metastatic kidney cancer The patients in red started off their therapy within the surgery on the kidney and took out the primary tumor And then received medical therapy that are fairly contemporary treatments like Sunitinib which is Sutent Seraphinib which is Nexivar or Bevacizumab which is Avastin Or patients that didn't have surgery and simply move forward with the same therapies applied for their metastatic disease And so at time zero survival is a hundred percent everybody's living as you move to the right if patients Progress their disease and die of their cancer. They're no longer living So the fraction of living patients falls away from a hundred percent But you want this bar to be close to the top of the frame here So higher is better lower is bad. And so the good line is the red line the patients that get surgery had better survival The bad line is the black line patients that did not have that type of surgery had had worse cancer survival So we think there's a therapeutic role for this debulking surgery And so by and large almost all of our patients in the kidney cancer clinic have had a kidney surgery And they're living beyond that with very often a single kidney. And so it does raise the question What does that mean for my life? What should I be doing about my kidney? What should I know about having abnormal kidney function? So dr. Kim Musinski will be here after the lunch break She's an associate professor in the nephrology division. So a kidney Specialist and her talk is assessing kidney function. How much do you really need and how to preserve what you have And kim was a speaker we had last year and if the patients I saw in my clinic after our presentation Far and away kim's talk was the one people pointed out and we're very excited about and very interested to have learned about And so we were very happy to have kim come back and revisit this topic again because I think it was very well received Some very envious of her her star attraction from last year. So we have her back again To end our program for our faculty speakers We'll then turn the program over to to you all to the patients And led by julie and our schmura our local Coordinators for the seattle kca chapter To present some materials have some patients Speaks us about their experience some of the treatments they have had and how that's gone And then we'll wrap things up at the end of that session Okay So let me move forward and kick off with our first speaker for the morning So dr. John goer is going to start us off with his talk that is surveillance for localized kidney cancer