Kidney cancer is one of the 10 most common cancers in the U.S.; according to estimates by the American Cancer Society, approximately 64,000 new cases of the disease will be diagnosed this year and about 14,000 people will die from it. Approximately 90 percent of kidney cancers are categorized as renal cell carcinoma (RCC).
In its early stages, RCC is usually asymptomatic. “The majority of patients have no idea that they have it,” says Dr. Paul K. Pietrow, of Premier’s Urology division, a specialist in urologic and kidney cancers. “In fact, most masses in the kidney are picked up incidentally, by other physicians, during scans or procedures for another problem.”
When RCC tumors are found in the early stages, the cure rate is excellent, upwards of 90 percent. “We can make such a difference,” says Pietrow. “Between us, the surgeons of Premier offer a wide range of techniques. We perform minimally invasive robotic and laparoscopic surgeries, percutaneous cryotherapy (freezing the cancer cells), and thermal ablation (killing the cancer cells with heat without harming healthy cells.)”
Advanced kidney cancer, Stages III and IV, are more difficult to manage. In these stages, a patient is likely to experience symptoms, such as blood in the urine, flank pain, unexplained weight loss, severe fatigue or a long-term fever in the absence of infection. “It is, of course, vital to see your doctor if you have any of these symptoms,” says Pietrow.
“Nine years ago there was only one therapy (Interleukin -2) available, which had only a modest benefit compared to newer drugs,” says Dr. Naeem Rahman, a Senior Partner in Premier’s Urology Division. Now, there are an increasing number of treatment options. “Between 2005 and 2013, two new classes of drugs were approved for treatment of RCC: mammalian target of rapamycin inhibitors (mTORs) and tyrosine kinase inhibitors (TKIs), both designed to target the vascular growth of RCC cells at the molecular level.”
To expand and metastasize, malignant tumors must form new blood vessels through a process called “angiogenesis.” TKIs and mTORS both interfere with the action of proteins in the tumor that are crucial to this process. These drugs are administered with the hope of slowing cancer growth and, in some cases, shrinking existing tumors. Results have been promising: Even in patients who have not experienced shrinkage of the tumor, the drugs have provided long periods of stable disease.
Not all patients will respond to a given medication, but with close to a dozen drugs now available in these classes, the likelihood of finding an efficacious medication has increased.
“These drugs are exciting,” says Pietrow. “Targeting vessel growth is a very novel line of attack. There is also another new development showing, in early studies, great promise in combatting advanced RCC.” Called “immune checkpoint blockade agents,” these antibodies block substances produced by the tumor that serve to hide it from the body’s immune system. Without this camouflage, the cancer cells become vulnerable to recognition and attack by the immune system.
Immunotherapy is currently being investigated and used to combat many forms of cancer; there are hundreds of clinical trials underway examining this avenue of treatment.
“Once it is firmly proven that these drugs expose the tumor cells to attack, we will finally have something truly efficacious,” Pietrow says. “More breakthrough discoveries will come as a result. Our RCC patients already feel a lot more optimistic about their condition.”