When managing kidney cancer, clinicians have traditionally used a one-size-fits-all approach. However, emerging evidence is demonstrating that all kidney cancer patients are not the same. Likewise, not all localized and metastatic kidney cancers are the same. Improving survival rates in kidney cancer is paramount, and several new targeted therapies that have been introduced to the treatment armamentarium have been shown to improve survival. As these therapies continue to emerge as viable treatment options, it’s important to determine the patients who stand to benefit most from them.
New Long-Term Data
In the November 1, 2008 issue of Cancer, my colleagues and I had a study published in which we assessed nearly 1,500 patients treated for kidney cancer in the last 15 years. Our investigation used an integrated staging system—developed at UCLA—which brought together medical oncologists, urologists, surgeons, clinical trial experts, and scientists for collaboration. A key finding of our study was that patients with localized kidney cancer could have low-, intermediate-, or high-risk cancers, and some may have better outcomes than others depending on the aggressiveness of the disease. Patients with low-risk, localized cancer had a 5-year survival rate of 97% and a 10-year survival rate of 92%. Those at intermediate-risk had 5- and 10-year survival rates of 81% and 61%, respectively. High-risk patients had 5- and 10-year survival rates of 62% and 41%, respectively. In the past, these groups of patients may have been treated in similar manners, but it’s clear that they should be treated individually according to their risk levels.
In patients with metastatic kidney cancer, our study showed that those with low-risk disease should receive aggressive treatment because they’re likely to achieved a survival benefit with this approach. Patients with high-risk, metastatic disease won’t benefit as much from treatment and may want to forego surgery or other toxic therapies. About 25% of patients with metastatic kidney cancer achieved long-term survival responses (5- and 15-year data) from therapy. However, less than 5% of these patients achieve long-term survival or disease remission when they received conventional treatments.
Using our integrated staging system, we were able to identify which patients with localized disease and which patients with metastasized cancers fall into which risk subsets. Based on this stratification, we can make treatment decisions that are most appropriate for individual patients. This is important because we can spare some people the difficult side effects that often accompany radiation or immunotherapy. We can also determine if other patients will be better off receiving targeted treatments or immunotherapy.
Using aggressive, personalized treatments for patients with kidney cancer can result in significantly better survival rates. Uncovering subsets of kidney cancer that behave differently can help clinicians treat patients more appropriately. Our study demonstrated some of the best survival data ever seen in a group of patients that is often difficult to manage, but these types of results should only be expected at kidney cancer centers of excellence. It’s critical for patients to have access to experts from all fields of medicine to optimize survival outcomes. Our investigation clarifies how the dramatic changes in kidney cancer care are affecting patient outcomes. In the future, it will be important to select patients who will be optimally treated using existing therapies and those who should be treated using newer therapeutic regimens.
Belldegrun AS, Klatte T, Shuch B, et al. Cancer-specific survival outcomes among patients treated during the cytokine era of kidney cancer (1989-2005): a benchmark for emerging targeted cancer therapies. Cancer. 2008;113:2457-2463. Abstract available at http://www3.interscience.wiley.com/journal/121426973/abstract.
Riggs SB, Larochelle JC, Belldegrun AS. Partial nephrectomy: a contemporary review regarding outcomes and different techniques. Cancer J. 2008;14:302-307.
Klatte T, Lam JS, Shuch B, Belldegrun AS, Pantuck AJ. Surveillance for renal cell carcinoma: why and how? When and how often? Urol Oncol. 2008;26:550-554.
Shuch B, La Rochelle JC, Pantuck AJ, Belldegrun AS. The staging of renal cell carcinoma. Curr Opin Urol. 2008;18:455-461.