Profiles in GU Oncology: Brian M. Shuch, MD

Brian M. Shuch, MD, describes his career path through 20 years, working with several leading urologists as mentors during his training.

When Dr Brian Shuch began his career, kidney cancer was a small field and less of a mainstream interest than other cancers, as there were fewer available therapies at that time, he recalls. Nowadays, in a much larger community, his work combines surgery (open/laparoscopic/robotic surgery and percutaneous ablations) and clinical/translational research. “I’m ‘all things kidney’,’” he declares. “If it has to do with kidney cancer, I’m very excited and motivated to be involved in it!”

As Director of the University of California, Los Angeles (UCLA) Kidney Cancer Program, Dr Shuch is responsible for coordinating clinical care and research studies for kidney cancer in a multidisciplinary setting. The Program offers patients a wide range of treatment options, including standard open and minimally invasive/robotic surgery and medical therapy, as well as a broad portfolio of clinical trials. Recognized as an expert in the genetics of kidney cancer, Dr Shuch also heads a translational research program at UCLA. He has been cited as “one of the few clinicians to bring their bench science to the bedside,” with an ongoing metastatic kidney cancer trial.

“Our overall goal is to match treatment intensity to the deep biology, and we know there’s it’s not ‘one size fits all.’ We would like to better individualize care for early and advanced stage kidney cancer,” he says.

Deciding to Study Oncology

Dr Shuch’s decision to study oncology was based on early family experience. “I come from a family of teachers who valued education and pushed me to find something that I was passionate about. That eventually was cancer biology, after a family member died from a glioblastoma,” he recalls. He first studied for a bachelor’s degree (BS) at the University of Michigan, where he became very excited about cancer, although his studies were not confined to oncology. “My senior thesis was on prehistoric salmon migration,” he reminisces.

After the University of Michigan, Dr Shuch attended New York University’s Grossman School of Medicine, graduating in 2004. He was already very excited about kidney cancer, having witnessed a partial nephrectomy. His mentor at NYU was Samir S. Taneja, MD, currently the James M. Neissa and Janet Riha Neissa Professor of Urologic Oncology in the Department of Urology, and Director of Urologic Oncology at NYU Langone Health, New York. “I wanted to be mentored by his mentor, which is why I came to UCLA. They had one of the strongest programs in kidney cancer,” Dr Shuch explains. “Basically, I’ve sought to be mentored by my mentors’ mentors each step in my journey,” he says. “It makes sense that if you’ve found someone and strive to be like them, you should understand how they got there by walking in their shoes.”

Dr Shuch sought out Dr Taneja’s mentor at UCLA, Arie S. Belldegrun, MD, currently Director of the UCLA Institute of Urologic Oncology. “He’s probably been the most impactful urologist in the world with involvement in multiple FDA approved drugs,” Dr Shuch says. Besides his academic career, Dr Belldegrun is well known for his successes in the pharma-biotech industry, having co-founded numerous biotechnology companies, including Allogene Therapeutics (South San Francisco, CA), a clinical-stage biotechnology company focused on the development of allogeneic chimeric antigen receptor (CAR) T-cell products for cancer. “We are currently working with Allogene Therapeutics on CAR T-cell therapy for kidney cancer,” Dr Shuch notes.

Starting a Career in Oncology

So in 2004, Dr Shuch went to work with Dr Belldegrun on kidney cancer at the UCLA David Geffen School of Medicine/UCLA Medical Center, where he played a key role in the Kidney Cancer Program, completing residency in 2010. Then, following a similar path to the one that led him to UCLA, he again sought to work with his mentor’s mentor. Dr Belldegrun was mentored at the National Cancer Institute (NCI) by W. Marston Linehan, MD, whom Dr Shuch calls “the godfather of kidney cancer genetics.” Dr Linehan is currently Chief of Urologic Surgery at the Urologic Oncology Branch, Center for Cancer Research at the NCI, Bethesda, MD. He and his team have identified numerous genes associated with hereditary kidney cancer and provided the basis for the development of new therapeutic strategies.

Following his plan, Dr Shuch started a Urologic Oncology Fellowship at the NCI, where he spent 3 years, training and “being mentored by a medical oncologist, Dr. Ramaprasad Srinivasan, to get more comfortable with clinical trials and systemic therapy.”

Dr Shuch was then appointed as an Assistant Professor of Urology and Diagnostic Radiology, and Director of the Genitourinary Cancer Genetics and Prevention Program at Yale University School of Medicine, New Haven, CT.  There, he focused on building a strong kidney cancer program following the launch of the new urology department in 2012. He also established a collaborative genetics program for the evaluation and management of patients with complex genetic disorders. As Director of the Genitourinary Biospecimen Repository, he also helped establish standardized collection and workflow for accessing patient cancer material, such as plasma, urine, blood, “with wide distribution to Yale cancer researchers and beyond.”

“It was a very productive time, establishing research collaborations with  amazing translational scientists, including Ranjit S. Bindra, MD, PhD,” Dr Shuch recalls. A chance meeting led to a fruitful collaboration and recent Nature and Nature Genetics papers. Dr Bindra is currently Harvey and Kate Cushing Professor of Therapeutic Radiology and Professor of Pathology and Scientific Director, Chênevert Family Brain Tumor Center at Smilow Cancer Hospital and Yale Cancer Center.

Working in Genetics

Having re-joined UCLA Health in 2018, Dr Shuch calculates that nowadays, he spends about one-quarter of his time in clinic seeing patients including those on trial, primarily in Westwood, the main UCLA campus—one-quarter doing kidney surgical procedures/surgery, and the remainder of his time on translational research activities.

In the era of improving targeted biologic and immune therapies for metastatic and high-risk kidney cancer, Dr Shuch confirms that he and his colleagues are performing less surgery nowadays. “We are doing a lot more surveillance, or a lot more needle-guided interventions or tumor ablation, and we are doing much less upfront surgery for patients with metastatic disease. We are doing more systemic therapy these days, where a lot of these patients will be going to medical oncology. However, I am keeping involved in this space to administer adjuvant therapy as a urologist can learn how to give these agents,” he stresses.

Dr Shuch’s work on genetics is split into two areas, he says. “We’re using information on genetics to guide individual patient management, to the drivers of their localized kidney; and we are also working on trying to understand genetic predisposition for patients who have unusual disease biology or family history. The former is really acquired genetic changes, called somatic mutations, and the latter would be the inherited or germline mutations.” His team has started a clinical trial to sequence renal masses to determine whether the acquired genetic mutations could help risk-stratify patients prior to treatment selection.

A Growing Career

In light of a national shortage of genetic counselors and the need to keep up with expanding criteria for genetic testing, UCLA launched an integrated telehealth cancer genetics program for patients with kidney and other genitourinary cancers. “We believe that this is a very scalable model across different practice types,” Dr Shuch says. “We aim to have next-day access and to do so, we partnered with a third party.”

Dr Shuch also finds time to serve as co-chair the SWOG Renal sub-committee and the NCI’s Renal Task Force, a subcommittee of the Cancer Therapy Evaluation Program (CTEP). “We’re trying to foster concepts that will improve the standard of care for kidney cancer,” he says.

Dr Shuch considers that for the past 20 years, his career has progressed, as he hoped to perform  transformative work in this field. “Kidney cancer is a great field with many great colleagues,” he enthuses. “The incidence is rising, and the complexity of management is also increasing.  So we need to train the next generation of motivated clinicians to understand the complex interdisciplinary management and identify and fill new knowledge gaps, so we can continue to advance the field with better treatment options,” he urges.

Linda Brookes, MSc is a freelance medical writer/editor based in New York and London.