GRACE :: Kidney Cancer

How is the Heng Criteria Applied to Kidney Cancer Patients?

Dr. Daniel Heng is the namesake of the Heng Criteria, which evaluates various factors of kidney cancer patients to determine their prognoses.


What is PD1 and PDL1 in Kidney Cancer?

Dr. Lauren Harshman explains what PD1 (an immune T-cell) and PDL1 (a protein on the PD1 T-cell) are and how new drugs impact them to fight kidney cancer.


No Clear Answer for Non-Clear Cell Kidney Cancer

Drugs in early stage clinical trials seem to show benefit for non-clear cell kidney cancer, but more trials must take place and patients are desperately needed to enroll in them.


Treating Newly Diagnosed Kidney Cancer

Dr. Guru Sonpavde discusses what he does when he first begins treating a patient recently diagnosed with late stage kidney cancer.


The Hottest Thing in Late Stage Kidney Cancer

Patients are responding very well to the next generation of immunotherapy drugs currently in clinical trials to treat kidney cancer.


Facilitating Partial Nephrectomy with Pre-Operative Pazopanib

When a patient has a localized renal mass, a partial nephrectomy is the desired surgical approach because it preserves renal function. Depending on the tumor size and location, a partial nephrectomy is not always possible. In these cases, pazopanib, a VEGF-targeted agent that has had an anti-tumor effect in primary renal cell carcinoma (RCC) tumors, may prevent patients from undergoing a radical nephrectomy and open up  the option of a partial nephrectomy. Dr. Alvarez and colleagues presented data at the 2014 ASCO annual meeting. In their study, 23 patients with clear cell RCC were identified who were not well suited for radical nephrectomy (due to poor kidney function, high risk of morbidity or complex vascular anatomy). Pazopanib was then administered for median of 10.6 weeks.  Tumor shrinkage was noted in 95% of patients, and ultimately 90% of patients were able to undergo partial nephrectomy.  Although this approach requires further validation, this might be an interest manner in which we can ultimately downsize kidney tumors and facilitate a less invasive surgical intervention.  

This post was co-written by Dr. Pal and Melissa Houlemarde


Combining Drugs to Improve Efficacy?

Patients with metastatic renal cell carcinoma (mRCC) are commonly treated by inhibiting VEGF and mTOR pathways.  Over the years, there has been substantial interest in seeing how inhibitors of these pathways can be combined.  In a phase II study presented by Dr, Kathleen Mahoney and colleagues at ASCO 2014, the combination of bevacizumab (a VEGF-inhibitor) and temsirolimus (an mTOR inhibitor) was explored.  Patients had both clear cell and non clear cell disease, and had failed prior VEGF inhibitors. Forty patients received this treatment until their disease progressed or they reached unacceptable toxicity. Ultimately, 77.5% of patients had a dose reduction, while 27.5% were taken off the study due to toxicity (e.g., fatigue, dyslipidemia, and proteinuria). These results are somewhat consistent with those from the TORAVA study, a large experience comparing this regimen to bevacizumab/interferon-alfa and sunitinib.  In that previous study, many patients were unable to tolerate full doses of each drug.  The combination resulted in a delay in cancer growth of 5.8 months in the overall study population. Impressively, in patients with non-clear cell disease, the delay in cancer growth was 7.6 months.  Thus, we might need to look further at this regimen for folks with non-clear cell disease. 

This post was co-written by Dr. Pal and Melissa Houlemarde


What Is Non-Clear Cell Kidney Cancer?

Among kidney cancer patients, the sub-type “non-clear cell” is the least common. As a result, not much research has been conducted on it.


Can Systemic Therapy Wait?

Patients with metastatic renal cell carcinoma (mRCC) with an indolent growth pattern may be able to put off systemic therapy and be observed for a period of time instead. Dr. Rini and colleagues presented data at ASCO 2014 assessing 52 patients who were observed for a median time of 14.1 months before their therapy was initiated. During this time the patients underwent radiographic assessment every three months for the first year, every four months during the second year, and after that every six months. Assessment of depression/anxiety in the patients was also conducted, and did not worsen during the observation period. These data suggest that a proportion of patients may safely defer therapy for mRCC, thereby delaying treatment-related toxicities.  Further work is needed to generate rigorous clinical criteria to identify patients who are candidates for observation.

This post was co-written by Dr. Pal and Melissa Houlemarde. 


The Obesity Paradox in RCC

Although being overweight does increase the risks for renal cell cancer (RCC), a recent study from Dr. Albiges and colleagues from ASCO 2014 shows that overweight or obese patients with kidney cancer have superior outcomes as compared to patients who are underweight or normal weight. The study was conducted in 1,975 patients receiving treatment for metastatic RCC (mRCC). The patients were classified as underweight/normal weight, overweight, or obese according to their body mass index (BMI) at the time of the initiation of targeted therapy. The findings showed that overweight or obese patients had a longer median overall survival in comparison to patients who were underweight or at normal weight (25.6 vs. 17.1 months). Biologic studies are currently being conducted to understand the paradox of a higher BMI increasing your risks of RCC, yet also possibly increasing survival rates for mRCC.

This post was co-written by Dr. Pal and Melissa Houlemarde.


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