 So while While we get our next speaker ready. I just wanted to address one question that was asked in the audiences How do we decide about can we comment anything about scans that are done? How do we pick between CT scans MRIs Pet scans and all of these other newer modalities that are available and I think all of those So we each test does different things. So an x-ray is probably the cheapest It's the one that has the least amount of radiation, but it's also one that gives us the least information So many of those so we use x-rays CT scans pet scans MRIs ultrasound and you saw some of the newer Imaging that Alice mentioned in her talk a lot of this really has to do with what information we are seeking and what would be the best so for instance When would we do a pet scan versus a CT scan? I think for the most part CT scan with contrast Gives us the best information that we can get but if you have poor renal function and you're unable to get a good CT with Contrast then a pet is very valuable. Why don't we do a pet in everybody? I think it has to do with the amount of radiation a pet scan carries a lot more Radiation than a CT does so I think it's always balancing What information we want what we can get and what price you're going to pay for that extra information? so So I wanted to talk a little bit introduce Tommy Metsner who's our Research coordinator extraordinaire who joined Stanford many many years ago He has a very personal story to say about why he got Interested in kidney cancer, but I would really say it's been a treat having Tommy in our urologic oncology department He's helped almost every one of us Collect specimens enhance our research. He helps consent patients about why they should be engaged in clinical research He helps collect blood samples tissue biopsies both In the operating room and has done tremendous work in helping many investigators here at Stanford Our personal hope and I know Tommy's hope himself is for him to become a physician one day And I think he's inching every day closer towards that dream. He also With his engagement has helped us Helped he himself formed this program getting medical students and pre pre med students engaged in Research and coming to our clinic in urology Concology, so Tommy's just going to talk a little bit about what he's done and his work in Helping enhance our research here at Stanford Can everybody hear me? Wonderful. Okay. Thank you, Sandy. Thank you for that kind introduction Hi everybody I Got a first start off by saying that this is one of my favorite events of the year so it's wonderful to be back here and have the opportunity to Give a talk to you guys again And so exactly what Sandy said is I'm going to talk to you a little bit about the research that we're conducting here at Stanford and specifically How we are acquiring and sharing knowledge about kidney cancer amongst the Investigators the physicians and the scientists here at Stanford with the hopes of improving treatments for kidney cancer patients So first I'd like to introduce myself My name is Thomas Metser, but everybody calls me Tommy. So you guys should as well Feel free and unlike my colleagues who presented earlier. I'm not a physician I'm a scientist. So I earned my bachelor's degree from the University of California, San Diego in human biology I also have a master's of science in biotechnology from Johns Hopkins University and Specifically, I'm a clinical research coordinator and research associate And so what I do is write and maintain clinical research protocols that allow us to conduct Human subjects research here at Stanford. So I write the protocols. I communicate with the Stanford institutional review board I Consent patients maintain clinical databases and then as a research associate. I also help develop novel science That's geared towards understanding kidney cancer So I run some experiments myself. I help troubleshoot assays Analyze data, etc. And I've been doing all this for seven years in total with five years committed to kidney cancer So when we think about clinical research, there's really two approaches to clinical research And what clinical research means is research that involves human subjects. So these two approaches are therapeutic and observational research studies So therapeutic research studies are ones that likely all of you are familiar with and these are also known as clinical trials And so these are treatments that are outside of the standard of care in which data is collected on the research and on the on the The treatment itself for the duration of the study that is as long as the patient is receiving say a therapeutic drug Or has undergone an experimental surgery It's our hope that patients will benefit from these interventions that being said that's not always a guarantee and There's also at times a risk associated with those interventions and those risks can be potentially very serious in Contrasts observational research studies are studies that involve the collection of information and data in the setting of a standard of care procedure And so examples of observational research studies are studies that involve the collection of tissue For instance when a patient undergoes surgery quality of life assessments and surveys As well as epidemiologic data mining and the beauty of these studies is that they can They can provide us with a tremendous amount of information about a particular disease At little to no risk to the patients and at very little cost to the researchers So to run a clinical trial costs literally millions of dollars and many years for a drug company To perform that research in contrast observational research studies can be done with small grants Led by investigators. They can be done in real time And as long as the investigator has a personnel and access to patients We can gain a lot of information in a short amount of time. And so both of these approaches to research are Incredibly important. I myself I conduct observational research. So I'm gonna talk to you a little more about that So at this point you might be thinking Who is this guy? He's just some science nerd who is interested in kidney cancer, right? Maybe he doesn't care that much about patients Well part of that is true. I am a gigantic science nerd. So I'll say that up front But I care tremendously about kidney cancer patients and to really illustrate that I want to introduce you to the first kidney cancer patient. I ever I ever encountered So this is Larry Larry is Well one of the best men I've ever known to be quite honest with you He was a Stanford alumnus class of 1973. He graduated with honors from this university He was also a very successful attorney and a philanthropist and was a pillar to his community in Alameda He lived right here in the Bay Area Of all the great things that Larry was My favorite thing about him was that he was my uncle and he was like a second dad to me Unfortunately Larry was diagnosed with stage 4 renal cell carcinoma in 2010. He had metastatic disease at the time of his presentation he went he underwent a Heroic bout with his disease involving numerous surgeries Spinal fusions a number of systemic treatments and unfortunately he succumbed to his disease in December 2011 at the time I was working as a Research assistant at the Scripps Research Institute in San Diego and I was studying cancer and During the course of his illness. I spent a lot of time with Larry and Before he passed away. I asked him. I said if you could learn anything about kidney cancer What would it be and he had two answers? He said number one. I want to know why me Why do I have this disease? I've taken good care of myself my entire life I have no risk factors for kidney cancer, let alone any type of cancer. I Have no genetic predisposition that I know of nobody in our family has ever had kidney cancer So why am I at 62 years old? Why do I have stage 4 kidney cancer? The second question that he wanted answered was is there a better way to To assign drug treatments because in his words, there's got to be something better than this goddamn suit and he was frustrated as all can be and you heard a little bit about Alex saying that we have a trial-and-error approach if you will to assigning systemic therapies in which we give a patient a drug and Hopes that it'll work and we re-image in 12 weeks and if it doesn't work we give them a new drug well, is there a better way of Going about that process and actually assigning therapy based on tumor biology and so that was a big thing to Larry That was a huge deal and the answers to those questions can be provided through observational research studies and So an example of what we're doing here at Stanford an observational research study here at Stanford is is what Dr. Fan talked to you about and this is a big project that I've been working on in which we Sample tissue specimens from patients who are undergoing nephrectomy to treat their kidney cancer We can run it through a fancy machine and it will produce a very specific protein profile of what proteins are Upregulated in a patient's tumor in the cells that actually comprise a patient's tumor And it's our hope that if we can isolate these proteins from very small amounts of tissue that we may be able to find Drug targets and thus more effectively assign a patient a treatment based on the proteins that are upregulated in their tumors as opposed to just giving a very broad A broad drug in hopes that it will work So this is an example of of one observational research study that we're conducting And if we can if we expand that we find that these protocols are actually able to Provide us with a tremendous amount of information again at no risk to the patients so we can have a patient who comes in with a large renal mass and If they're going to surgery we can collect tissue specimens if they have metastatic disease We may collect blood samples in hopes of isolating circulating tumor cells Which are cells that have broken off of the main tumor Entered into a patient's vascular system and are by that means circulating around and that's essentially the root for Metastasis or the spread of a patient's kidney cancer outside of their kidney along with those types of studies We may also collect urine and blood as a way of Seeing if we can find a patient's kidney tumor or an indication that they have kidney cancer based on Biomarkers they're in their blood or in their urine that would prompt a CT scan as opposed to having an Incidental finding of kidney cancer in which we find it on a CT scan when we're looking for something else like a back injury or kidney stones Abdominal pain can we find these tumors earlier and can we treat them earlier when they're more surgically manageable and when they haven't spread outside the kidney? along with those types of studies we can also collect information from a patient's medical record and Compile large databases for patient outcomes and assessing what types of risk factors a patient might have for developing kidney cancer who gets kidney cancer and You know if a patient receives a certain type of treatment, what is their outcome likely to be? And we can also collect these Tissue specimens put them into mouse models and test drugs and see if a particular type of drug is more Effective at treating kidney cancer than say another drug and we can also understand the biology of metastasis and The formation of all of these clinical research studies and the implementation of these research practices Has provided the infrastructure for the kidney cancer research program here at Stanford so the kidney cancer research program utilizes an Umbrella of observational clinical research studies to provide in information to a consortium of kidney cancer researchers here at Stanford and these researchers are both Physicians and scientists from multiple disciplines across the university and what we all have in common is that We're all interested in kidney cancer and through the kidney cancer research program We're able to meet and share information so that we can more effectively study this disease And so we have folks in the research program like Alice fan and Wendy Phantle here on the right who are studying At ways to predict response to a particular therapy you saw dr. Lepper earlier myself dr. Jim Brooks We're interested in proteomics and molecular and cellular biology You have dr. Srinivas dr. Chung who you've heard from they maintain a kidney cancer database here That's just full of clinical information on patients with kidney cancer so that we can assess trends large in large populations of kidney cancer patients Dr. Amato Giaccia and Aaron Rankin they're studying drug targeting and resistance and then we also have specialists who have developed animal models that are incredibly effective at mimicking kidney cancer in a mammalian system and we can trust we can test drugs on those those tumors that we implant in these mice and so Dean Felscher Jeffery Gertner and Dr. Donna Peele are instrumental in that and this group meets twice a month and We just talk about kidney cancer and it's a it's a means by which we are getting everybody in the same room a meeting of the minds if you will to really approach this disease in a way where we can utilize our strengths to overcome the challenges and the hurdles of studying a cancer that is as complicated as kidney cancer and Along with this the kidney cancer research program I'm really proud to announce a project that I took on and founded myself So the Larry and Diana Luloff's Memorial kidney cancer research internship is an internship. I started in memory of my uncle Larry Initially it bore only his name, but I changed it because in February of this year Unfortunately, my aunt Diana who is Larry's wife succumbed to her own battle with lung cancer and Though she wasn't a kidney cancer patient. I added her in because There was no greater caregiver to Larry than his wife excuse me and So this is this has really been my brainchild and I I founded this program and I'm proud to say that it is up and running here and So what it is? It's a six-month paid internship for Stanford undergraduates. It's available to all undergraduates except for freshmen because we want students to have some some collegiate Science coursework under the belts before they start this program And it provides a three-month clinical rotation followed by a three-month research rotation That's geared towards studying kidney cancer. So during their clinical rotation the students shadow physicians Specifically oncologists and urologists in the GU oncology clinic as well as in the operating room learning about kidney cancer understanding treatment paradigms for this disease and meeting kidney cancer patients and their families so that they can understand Really understand the challenges associated with this with this disease Following their clinical rotation the students take part in a research rotation in which they work on a Translational research project with one of the members of the kidney cancer research program that's aimed at improving treatments for kidney cancer And this program has two aims number one it's to increase in the awareness and interest in renal cell carcinoma for future physicians and Scientists and it's also geared towards facilitating students getting into doctoral programs and specifically this program places an emphasis on Underprivileged students here at Stanford who otherwise would not be able to acquire time working with physicians being able to do research Etc. And at at the core of this project our observational research studies That really allow students to gain this information So I'm proud to say that in 2017 we graduated two students two outstanding interns through this program So on the left is Jasmine cap Rudin. She's from the Stanford class of 2019 And on the right is Caitlyn like a tutor who is a Stanford class of 2018 and Caitlyn's actually sitting right there And she's my latest superstar So big round of applause. She completed the program last month And so I want to introduce these remarkable women a little bit about Jasmine She was born and raised in South Central Los Angeles This is a picture of her and her mother at her high school graduation Jasmine's mom is a paraplegic and as a teenager. She helped take care of her mother So she has one of the most profound senses of caring and compassion for others other people. I've ever met from a young person Her majors are political science and African-American studies She was the first in her family to attend college and she completed the Lulafs internship in June She worked with me from January to June of 2017 and her future goals are to go to medical school and earn a medical doctor. Sorry There we go and a little bit about Caitlyn. She's from Davis, California. Her major is computer science She actually did a condensed form of the Lulafs internship So she worked three months, but she did twice the amount of time in a week that a normal intern would do So typically they do 12 weeks She did 24 and she did it over the course of the summer while studying for the MCAT. I will say She completed the internship like I said in September and Interesting thing about Caitlyn. She was a three-year varsity athlete. She's a softball player here at Stanford her future goals are to go to medical school and Also to potentially earn a PhD so as I said, they start with they start with clinical rotations and Initially, they they undergo a mastery of the literature. So they're required to learn about the biology of kidney cancer understand his treatment paradigms and then they start working with physicians and These are this is a picture of both of these ladies on the left is Jasmine observing an open partial nephrectomy in the operating room And on the right is Caitlyn. She's observing a robotic partial nephrectomy She's sitting at a teaching console that we actually have in the operating room for our resonance So the attending physician is operating at a similar console and she's able to look in and see the exact view that the surgeon is seeing She's obviously not operating But she gets to observe and these are incredible experiences that the majority of undergraduates at Stanford don't get to experience these ladies are in surgery or weren't surgery Typically one case a week. So they'd spend one day in the operating room Splitting their time in the OR and then one to two days in the clinic working with medical oncologists and urologists and working with patients and Then following their clinical rotations. They undergo research rotation and so Jasmine worked in the lab of Alice fan She was mentored by Dr. Christian Horner who's a staff scientist and and the lab manager for the fan lab Specifically she was interested in investigating mechanisms of drug resistance So why a drug is initially efficacious and then loses its ability to Inhibit a patient's cancer. So she worked on that for three months She also presented her work at the GU oncology translational research meeting and part of the requirements for this program is that the student must Give one public talk on their work so that they can gain their voice and they can get used to sharing information and contributing to the field Caitlyn on the other hand she worked in the laboratory of dr. Christina Curtis She was mentored by Jose Sione who's a postdoc in dr. Curtis's lab and she's interested in genomics So she studied and is studying Mechanisms by which gene expression could potentially be associated with the development of metastatic disease and The faculty in the urology department loved her work so much that she will be speaking at next month's Grand rounds, which is a big deal for an undergraduate to be presenting at surgical grand rounds with the urology department So the gist of this story is that the future is bright as far as research is concerned on kidney cancer at Stanford The Stanford kidney cancer research program is facilitating collaborations and co cooperative grant writings that we're hoping will lead to Knowledge being presented to the field that's going to improve treatments for this disease We're also providing future physicians with an understanding of this disease. We're educating young people and Most importantly, we are inspiring young scientists and the proof is really in the pudding with this because both interns Have chosen to continue their work in kidney cancer research even after completing their internships So Caitlyn has just been brought on by the Curtis laboratory as a research assistant an undergraduate research assistant And Jasmine is currently at the University of Oxford completing an internship on public policy She'll then be working in DC on health policy in the winter and when she returns in the spring Her hope is to continue her work with dr. Fan and dr. Fan has Has confirmed that that is a possibility so she's going to come back and she'll be working on kidney cancer when she comes back In the fall excuse me in the spring and so with that I want to say a tremendous. Thank you To all of our patients and their families everyone who participates in this in this research whether it's Observational research or whether it's therapeutic research. You're really providing information that is invaluable to us and is going to help future patients certainly and It's also providing a mechanism of of training and educating the future generations of kidney cancer physicians and researchers and With that I'm happy to answer any questions and if you'd like more information On the Stanford kidney cancer research program or the Lulofs internship you can follow the two links at the top Also, if you're interested in looking into therapeutic clinical research studies ie clinical trials you can find those at clinical trials gov or The bottom website is a clinical trials website for our trials that are available here at Stanford And I'm happy to take any questions you mentioned that you were doing Observational studies and one of the things you did was to take tissues Yes, okay, so if you've already had a Partial nefractomy is there a way of getting tissue or doing some kind of blood work that could determine the prognosis of future metastasis Currently currently no, but that's exactly what we're what we are investigating So I would say that in an interesting approach to that for example We had a study going in which we're collecting blood specimens from patients who are undergoing nefrectomy Partial and radical nefrectomy, so we would collect blood At the time of surgery before that the tumor was resected So we would get that from the patient's arterial line in the operating room while they were asleep from a line that they Have in already and then in the days following their surgery when they were recovering in the hospital We would also draw blood and analyze that for circulating tumor cells. So what we were trying to decipher was Did they have? Were there tumor cells that were present in the blood before they went to the operating room and then were there was there a Change in the numbers of of cells After the tumor was resected. So that would be a potential approach to answering that question. You could also take a look at Self-free DNA so levels of DNA that are present in a patient's blood pre and post Surgery and if you don't see a change then you could potentially theorize and maybe they have micrometastatic disease Unfortunately, none of these assays are at a point where we can utilize them to make clinical decisions That's why they're currently just observational research studies But those types of approaches to patient care have to start from somewhere and that's really where the observational studies come in One thing I would add to that is for patients who's who have already had surgery in the past You know in order for us to do anything with the existing tissue We need patient's permission so none of those can be done if you actually don't get a consent from you So that's why some of the ones that we are doing now. We are prospectively getting consent That's what Tommy does. He goes prior to surgery Really asking if it's okay if you were to contribute a piece of your tissue So we can do anything with what's already taken without actually getting patient's permission Okay, thank you so much