I am a medical oncologist who cares for people with genitourinary cancer. I specialize in treating testicular cancer (germ cell tumors) and kidney cancer (renal cell carcinoma). My research centers on developing new drugs or drug combinations for people with these cancers. I also lead national and international clinical trials for people with genitourinary cancer. When I meet with people who have recently been diagnosed with cancer, my goal is to help them feel informed about their disease and treatment options. I want them to be confident that they are going to get the best care possible. I reassure them by discussing our vast experience with treating their illness and preventing and addressing treatment-related side effects. Studies have shown that people whose cancer is treated at an experienced cancer center like MSK achieve better outcomes than those treated at less specialized institutions. I am proud to be among the most experienced doctors caring for people with testicular cancer and kidney cancer. Equally as important, I treat my patients with compassion and respect, just as I would want my own family to be treated.

TESTICULAR CANCER AND GERM CELL TUMOR (GCT) RESEARCH:

I direct MSK’s testicular cancer and extragonadal germ cell tumor (GCT) research program, which addresses all aspects and stages of the disease. One trial that we are especially proud of, called the TIGER trial, is an international randomized study seeking to establish the standard of care treatment for second-line chemotherapy for patients with GCT whose tumor progressed or recurred following first-line treatment.  The trial tests two regimens developed through research at MSKCC, including the standard-dose chemotherapy regimen, TIP, and an intensive treatment regimen called TI-CE which consists of high-dose chemotherapy with stem cell transplant. TIGER, led by me and the team at MSKCC (through our National Cancer Institute cooperative group affiliation), is the first international transatlantic randomized clinical trial to be successfully completed in GCT.  We are also studying various therapies and the effectiveness of treatment combinations, including immunotherapy and targeted therapies, in patients with tumors that continue to relapse despite our current treatments. These studies offer hope to patients who otherwise would have limited therapeutic options available to them. In 2023-2024, we hope to bring a novel bispecific antibody program and chimeric antigen receptor T-cell (CAR-T) therapy option to MSKCC for these challenging group of GCT patients. 

In collaboration with the laboratory of Dr. David Solit and other colleagues, my group has also focused on determining the biologic basis for why some of these cancers are resistant to chemotherapy.  We identified two key genomic alterations in germ cell tumors that predict for chemotherapy resistance and are currently working on developing a clinical trial for patients with these alterations. Another recent project we have been working on in collaboration with Dr. Fei Ye of Laboratory Medicine concerns development of a novel blood marker that can be used to diagnose and track a patient’s cancer status. This test, called the MSKCC microRNA assay (MMA) appears to be more accurate than the classic tumor markers AFP, HCG, and LDH. We hope that we can use this to help guide treatment decisions and monitor patients for recurrence, lessening our reliance on CT scans and other imaging tests. Finally, we one of the only groups studying why patients get GCT in the first place, including evaluating genetic predisposition in collaboration with Dr. Zsofia Stadler of the Clinical Genetics Service. 

KIDNEY CANCER (RENAL CELL CARCINOMA) RESEARCH: 

People with kidney cancer are now benefitting from advances made during the last 15 years, many led by researchers at MSK. We now have more treatment options than ever to help control the disease. Immunotherapy and targeted therapies combined with immunotherapy are producing unprecedented response rates and survival outcomes.

My kidney cancer research is focused on integration of new types of PET imaging and radiolabeled targeted therapies for people with advanced renal cell carcinoma (RCC), which has shown resistance to standard treatments. This approach has already proven highly successful in prostate cancer. Our approach at MSKCC leverages the fact that the most common type of kidney cancer, clear cell RCC, nearly universally has a marker, called carbonic anhydrase IX (CA-IX), on its surface. Working with nuclear medicine colleague, Neeta Pandit-Taskar and her team, we are studying labeling an antibody to CA-IX, called girentuximab, with the non-harmful radioactive material, Zirconium to more accurately identify metastatic disease, even when it is too small to be seen on conventional CT scan imaging. The ability to better appreciate whether metastatic disease is present or not and when present, where it is located, will help us better tailor treatment to patients and improve outcomes. On the therapeutic side, we are evaluating the effectiveness of administering the immunotherapy agent, nivolumab, in combination with Lutetium-labeled girentuximab can achieve responses in patients who have already progressed on prior kidney cancer treatments.  This is a completely novel approach to treating kidney cancer that as of January 2023 is only available at MSKCC. 

I am also working to better understand non-clear cell renal cancer, which is less common.  In collaboration with my colleagues, Dr. Voss and Dr. Lee, we demonstrated some of the highest response rates ever reported in non-clear cell RCC with two regimens; 1) bevacizumab plus everolimus, and 2) cabozantinib plus nivolumab. Our work has led to incorporation of both regimens into the NCCN guidelines for treatment of these challenging and more rare tumors. Our current research efforts continue to explore novel approaches to treating non-clear cell RCC patients.