The Rampart study's main contribution wasn't its specific drug data, but that it became the second positive trial in the adjuvant kidney cancer space. This balanced the 'scorecard' against multiple negative trials, reinforcing the general principle that early immune therapy is beneficial.

Launching an autologous cell therapy is complex, involving a nephrologist, a biopsy doctor, and an interventional radiologist. ProKidney's CEO notes success requires standardizing this process to ensure a seamless, best-in-class experience for both the patient and all involved providers, which may mean a slower, more deliberate initial rollout.

Despite significant academic interest, the KIM1 plasma biomarker is far from clinical implementation. Key hurdles include the lack of a commercially available, standardized assay and prospectively validated cutoff points. It remains an experimental tool with high variability and unproven utility.

The Uromigos score (0-3) provides a rapid expert consensus on new treatments. It bridges the gap between slow, formal guidelines and long, unprioritized lists of approved therapies, offering a more immediate assessment of a drug's place in the standard of care.

Lutetium faces criticism for its fixed 6-cycle regimen, which may be suboptimal as the PSMA target diminishes with ADT. However, this critique is rarely applied to other drugs like PARP inhibitors, which are given until progression. This highlights a double standard and the tension between using a fixed regimen for regulatory approval versus finding the optimal dose in practice.

Despite strong efficacy data, the drug DV-Toripalimab scored lower than a competitor (2.5 vs 3.0). Experts attribute this confidence gap to its Phase 3 trial being conducted only in China, which raises generalizability concerns and reflects a lack of hands-on experience for Western physicians.

Sepsis is not a monolithic condition. The failure of more than 100 immunomodulatory drug trials is likely because they treated all patients the same. The future of sepsis treatment mirrors oncology: subtyping patients based on their specific inflammatory profile to match them with a targeted therapy.

A significant criticism of the pivotal KEYNOTE-564 trial is that only half the patients in the control arm received standard-of-care immunotherapy upon relapse. This lack of subsequent optimal treatment complicates the interpretation of the overall survival benefit, raising questions about its true magnitude.

The Rampart study's use of the Leibovic score for risk stratification is a key strength. Unlike traditional TNM staging, this score more heavily weights tumor grade, which clinicians find to be a more granular and clinically relevant predictor of recurrence risk than just tumor size.