Renal Cell Carcinoma - Episode 3

Approaching Treatment for RCC

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Kidney cancer expert, Dr Thomas E. Hutson, comments on treatment approaches for the management of renal cell carcinoma.

Thomas Hutson, DO, PharmD: When one approaches treatment for renal cell carcinoma, there are a variety of approaches that we need to take into consideration. First off, is whether or not a patient would benefit from a nephrectomy. Now, we know for patients that are in stage 1, 2, 3 that doing a nephrectomy or removal of the mass is potentially curative. We also know that in patients that present with metastatic disease at the time they’re diagnosed, which is a patient that has a kidney mass but also has areas in the body with cancer spots that removing the kidney may also be a benefit to them. This concept of removing the kidney despite already having metastatic disease has been highly studied and based upon the benefits of newer therapy, it’s now somewhat debatable.

So, in the past before we had effective therapy, we would try to remove as much of the cancer as possible, even if it had already spread. But now with newer-generation therapies that have much greater activity and ability to control the cancer, and in some cases actually shrink the cancer, the benefits of removing the kidney is now questioned. Thus, depending upon how the patient is presenting, are they symptomatic from their cancer, do they have other medical conditions that would make a surgery difficult, do we think that the recovery from the surgery, which may take one or two months, would allow the cancer that’s remaining in the body to grow to a point that would make treatment difficult. In those settings, we would consider forgoing nephrectomy and proceed forward straight with systemic therapy.

When I mean systemic therapy, I mean therapy that a patient takes that is designed to go into the body, circulate everywhere in the body, and treat all spots of cancer. Thus, that is becoming more and more common. In fact, there have been 2 large trials that have shown that we should be more careful in who we choose to do nephrectomy in, and we should err on the side of not doing the nephrectomy, and going ahead and starting patients on systemic therapy today. Again, this is a representation of the advances that we’ve made in systemic therapy. We have therapies that are able to control and shrink the cancer much better than in the past.

Thus, when we start thinking about systemic therapy, there are two groups of patients now that are going to be potentially eligible to start systemic therapy. It’s going to be that group that we discussed earlier, that is presenting with metastatic disease at the time when they receive a diagnosis, and we said roughly that’s 20% to 30% of patients. The other group of patients are going to be patients that develop recurrence after curative intent therapy. That is going to be – it could be as high as 20% to 30% of patients that present with localized disease.

This transcript has been edited for clarity.