Nicholas Cost, MD, associate professor of surgery in the Division of Urology at the University of Colorado Department of Surgery, has become the first surgeon to be named chair of the Renal Tumor Committee for the Children’s Oncology Group (COG). The Children’s Oncology Group is a National Cancer Institute-supported clinical trials group and is the world’s largest organization devoted exclusively to childhood and adolescent cancer research.
A member of COG for the past 15 years, Cost led the surgical side of the Renal Tumor Committee before stepping into the role of chair in July. The committee oversees research on pediatric kidney cancers including Wilms tumor — which accounts for about 85% of all pediatric renal cancers — additionally including clear cell sarcoma of the kidney, renal cell carcinoma, and malignant rhabdoid tumor.
“The mission of the Children's Oncology Group is to conduct research to improve the care of kids with cancer, and they oversee it for all different kinds of pediatric cancers,” Cost says. “They also oversee a lot of work around biologic studies, serving as a library of tissue and samples that can help us understand things maybe we don't even know right now.”
The Renal Tumor Committee has collected tissue and samples over the past 25 years, Cost says, allowing researchers to go back after clinical trials are complete and identify new markers for prognosis that can be incorporated into future trials.
Cost has seen treatment for Wilms tumor and other pediatric kidney cancers change over the past few decades, thanks in part to research conducted by members of the COG Renal Tumor Committee.
“Ten or 15 years ago, everybody got very similar treatment,” says Cost, a member of the CU Cancer Center. “Now we understand that some kids with a very favorable prognosis can just get surgery and not need chemotherapy, while others have poorer prognoses, with cancer that has spread outside the kidney, and they will need chemotherapy, radiation, and surgery. But by and large, we have been able to narrow the rate of cure between the two ends of the spectrum.
“The ability to personalize the care to achieve a high rate of cure is very impressive when you're talking about a disease that in the U.S., there's only 500 or 600 cases a year,” he adds. “We’ve been able to go from a cure rate of around 30% or 40% in the 1930s and 1940s to over 90% today. That's only possible because we have this cooperative group that brings almost all of these cases together, so we learn something from every patient.”
Cost’s new role with COG involves a good deal of travel, he says, including attending group meetings and executive retreats within the U.S. as well as meetings with partner organizations in Europe.
“They also run trials, and they have different disease committees, including a renal tumor study group,” he says. “We collaborate with them to harmonize our research — it doesn't make sense for us to do the same trials. We want to be complementary.”
One of his most important responsibilities as chair, Cost says, is helping to nurture the next generation of leadership within the group.
“You can't expect to have good leaders emerge if you haven't emphasized their growth at the beginning,” he says. “It has to be a logical, thoughtful transition of bringing in new people, developing them, identifying their strengths, helping them grow, and watching them mature.”
As head of a committee devoted to research, Cost knows it’s important for him to look far ahead when it comes to clinical trials and other studies.
“I spend time thinking about not just the current clinical trials and the ones we have in development that we hope to open soon, but also the study after this one and after that one,” he says. “We want to be more proactive than reactive and think about where the field is going so we can have the answers ready. Doing these studies takes a long time. These families deserve the best, so we want to be thinking ahead of what they might need.”