Grant: Travel Awards - Institute Community Support

Over 30% of kidney cancer patients are diagnosed at the advanced stages of their disease. Despite the advent of new, more effective treatment options, a late-stage diagnosis of kidney cancer generally remains fatal. Improving patient survival will require the development of new methods for better predicting a patient's response to therapy. In other cancers, researchers have developed blood-based tests that are capable of isolating DNA fragments shed by dying tumour cells. These DNA fragments, called circulating tumour DNA (ctDNA), can be used to non-invasively explore the genetic makeup of a tumour, allowing doctors to more precisely administer treatments using the tumour's genetic vulnerabilities. To explore the utility of this technology in advanced kidney cancer, I collected blood samples from 55 patients and performed ctDNA sequencing across 964 cancer-related genes. I also obtained matched tumour specimens, where possible, to assess the similarity between our ctDNA findings and DNA sampled from the original tumour. In this study, we determined that ctDNA was present in only a minority of patients with advanced kidney cancer (33%). Among ctDNA-positive patients, levels of ctDNA were much lower than our findings in other common cancer types - such as prostate and bladder cancer. We were also unable to predict which patients would be ctDNA-positive using their clinical characteristics. However, when ctDNA was detected, there were clear similarities between the genetic changes in both the ctDNA and matched tissue specimen. We also observed that patients with the highest levels of ctDNA got sicker faster and died earlier than patients without ctDNA. Further studies using greater numbers will be required to confirm whether ctDNA can be used to inform clinical management and predict a patient's response to treatment.