Tailored therapy may improve kidney cancer survival

NEW YORK (Reuters Health) - A study of nearly 1,500 patients treated for kidney cancer at the University of California-Los Angeles in the last 15 years indicates that patients may benefit from an individualized treatment approach.

"We have shown that not all kidney cancer patients are the same, not all localized kidney cancers are the same and not all metastatic kidney cancers are the same," lead researcher Dr. Arie S. Belldegrun from the UCLA David Geffen School of Medicine noted in a written statement. "We outline the foundation for personalized kidney cancer therapy."

As reported in the November 1st issue of Cancer, Dr. Belldegrun and colleagues investigated cancer-specific outcomes for 1,632 patients treated for renal cell carcinoma (RCC) in the cytokine era (1989-2005). Patients with localized or metastatic disease were classified using the UCLA Integrated Staging System into low-, intermediate-, and high-risk groups.

Nephrectomy was performed in 1,492 patients.

For localized RCC, the 5- and 10-year disease-specific survival rates were 97% and 92% for the low-risk group, 81% and 61% for the intermediate-risk group, and 62% and 41% for the high-risk group.

"In the past, all of these patients with localized cancers...may have been treated the same way," Dr. Belldegrun said. "They need to be treated individually according to their risk levels."

The data from this cohort indicate that "nephrectomy alone is not sufficient to cure all patients with clinically localized RCC and that effective adjuvant therapies are needed for those with high-risk disease," the researchers note in their report.

For metastatic RCC, the 5- and 10-year survival for low-, intermediate-, and high-risk groups was 41% and 31%, 18% and 7%, and 8% and 0%, respectively.

"Our paper identifies, very precisely, which patients should get which therapies," Dr. Belldegrun said.

For example, a low-risk patient with localized disease could expect a very good outcome with surgery alone. On the other hand, the researcher explained, a low-risk patient with metastatic cancer should get very aggressive treatment, because the odds are good that the therapy will help. Those with high-risk, metastatic disease, however, are unlikely to benefit from treatment and may want to forego surgery and toxic therapies.

The researchers suggest that the survival rates detailed in their paper be used as a benchmark with which to compare three recently approved targeted therapies for kidney cancer -- sorafenib, sunitinib, and temsirolimus.

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