Q&A: Dr. Daniel Shapiro, 2026 KCA Grant Winner
Dr. Daniel Shapiro received the 2026 Kidney Cancer Association/Rising Tide Foundation Clinical Cancer Research Award for Early Detection and Diagnosis of Kidney Cancer. Dr. Shapiro’s research will focus on “Integrated Biomarker and Tumor Microenvironment Profiling to Improve Prognostication in Localized RCC”, which could help individualize kidney cancer treatment after surgery. Dr. Shapiro is an Associate Professor of Urologic Oncology at the University of Texas MD Anderson Cancer Center. We spoke with him about his research and the impact it can have on people with kidney cancer.
Describe your project and how you developed the idea.
Many people with kidney cancer have surgery that removes the tumor completely, and for a lot of them that’s the end of it. But for a meaningful share of higher-risk patients, the cancer comes back, and right now we have limited ability to know in advance who those patients will be. We estimate risk from the tumor’s size and its appearance under the microscope, which gives us some insight, but we have seen many times that these features offer only a rough idea of how likely a tumor is to return.
This project tests two blood markers in patients after kidney cancer surgery: circulating tumor DNA, small fragments of DNA that cancer cells shed into the bloodstream, and KIM-1, a protein released by kidney tumor cells. The blood is drawn at visits patients are already having, so there are no extra appointments. We then ask whether these markers, combined with the standard information we already collect, give a more accurate picture of who is likely to recur. In a subset of patients, we will also study how the tumor and the immune cells within it are structured and organized, to understand why some tumors shed these signals and others don’t.
The idea came from a few places. In 2024, I helped lead a consensus effort at the International Kidney Cancer Symposium: North America Think Tank where researchers and patient advocates ranked the most promising biomarkers to develop, and these two were at the top of the list. In an earlier study in patients with metastatic disease, our group found that both markers tracked closely with outcomes. And kidney cancer has long been notoriously difficult to detect with earlier generations of circulating tumor DNA tests. The test we are using is designed specifically to overcome that limitation. The natural next question was whether these markers work after surgery, where the uncertainty for patients is greatest.
Why are biomarkers, especially ones detectable in a blood test, so difficult to identify in kidney cancer?
Kidney cancer is an elusive disease. It often causes no symptoms until it is advanced, and we are now learning that it hides in the bloodstream as well. Compared with many other solid tumors, it appears to shed very little DNA into the blood, so a test that works well in colon or lung cancer may simply miss it. On top of that, kidney tumors don’t carry the kind of mutations that make some cancers easy to track. The genetic changes vary from patient to patient, which means a test often has to be designed around each person’s own tumor rather than taken off the shelf.
Timing is the other problem. After surgery there may be only a few cancer cells left anywhere in the body, so the signal we’re looking for is faint, and recurrences can happen years later. Proving that a marker works means following patients for a long time and collecting samples carefully along the way. That is slow, expensive work, and it is part of why kidney cancer has lagged behind other cancers in this area.
What is the most exciting thing about your research for patients and families?
The possibility of a more honest answer to the question every patient asks me after surgery: is it gone and will it come back? Today our answer is a guess based on a large group of patients who may or may not resemble the patient sitting in my clinic. A blood test that reflects what is actually happening in each patient’s body, designed on their individual tumor, could let us tell some patients, with more confidence, that they can be followed less intensively, and could let us identify others who would benefit from additional treatment or closer monitoring before anything shows up on a scan. The patients who helped design this study told us the uncertainty between scans is one of the hardest parts of recovery. Reducing that uncertainty and doing it with a blood draw rather than more scans or procedures, is what I find highly compelling about this work.
What motivates you?
As a surgeon, I meet patients at the moment they are hoping an operation will be the cure, and I see some of them again when it wasn’t. The hardest conversations I have are with patients whose cancer has returned after they believed it was behind them. What drives me is the prospect of changing those conversations. If we could identify who stands to benefit from additional treatment and intervene before a tumor spreads, and just as importantly, who can be spared the therapies and scans they will never need, we would not only improve how we care for these patients but lift a great deal of the anxiety they carry between visits. The problem is that the tools we rely on today, the tumor’s stage and its appearance under the microscope, describe the cancer we already removed. They tell us about the past. A blood test can tell us what is happening in the body right now and predict what may be coming. For too long, we have been driving by the rearview mirror.
What else do you want others to know about you or your research?
This study is already enrolling patients, and every blood sample is drawn at a visit that would be happening anyway. That was a deliberate choice, and it reflects how the study was built. Patient partners have been at the table from the first conversation about the research question and will remain there through the final step of explaining what the results mean to patients. They will be co-authors on the work we publish, and it has been a privilege to work with and learn from them. Their perspective has made this research better in ways we would not have arrived at on our own.
Looking ahead, I hope to bring this work together with my laboratory’s broader research program focused on the immune response to kidney cancer. Blood-based markers such as circulating tumor DNA and KIM-1 can tell us whether cancer may still be present. Immune-based markers, which measure how well the immune system is organizing itself to attack the tumor, can tell us something about the body’s ability to control it. Neither on its own gives the full picture. By combining them, I believe we can build a far more complete and sophisticated understanding of each patient’s prognosis than any single test could provide.