Treatment
The Renal Tumor Clinic at BIDMC offers individuals with renal tumors the highest level of medical care and coordinated services. Patients benefit from state-of-the-art technology and multidisciplinary treatment from leading specialists in urology, radiology, laparoscopic surgery and hematology/oncology.
As the only Clinic in Boston to focus exclusively on kidney cancer, we provide patients with a broad menu of options.
Surgery
Surgery is generally the first line treatment for kidney cancer that has not spread. Laparoscopic surgery is common technique that allows for a minimally invasive operation. Laparoscopy involves the surgeon making small incisions in the abdomen to insert a small light, a camera, and other instruments that are used to view and remove the tumor. It has been shown that laparoscopic surgery is as effective as traditional surgery, and it easier to recover from.
Immunotherapy
Another type of treatment, called immunotherapy (often referred to as Biological Therapy), uses medications to increase the body's natural ability to fight cancer. One of the problems with cancer is that it uses the body own defenses against it, and since nothing foregin (like a virus or bacteria) is introduced, the body does not recognize the cancer as unwanted and does not fight it. One can think of immunotherapies as a way to jump start the body's natural immune system into realizing that the cancer is undesirable. Two such drugs - interleukin-2 and interferon alfa - have been shown to cause some kidney tumors to shrink by more than half. Unfortunately, immunotherapies tend to only work in about 10-15% of patients. Research is underway to identify patients who would be most likely to benefit from immunotherapy. In the meantime, immunotherapies are frequently combined in tandem with targeted therapies.
Targeted Therapies
Through the pioneering work of Harvard doctors like Judah Folkman, researchers have learned that cancer cells are often able to proliferate and spread due to a phenomenon called angiogenesis. Angiogenesis involves the growth of new blood vessels, and is a normal process in healing infections. Like normal tissues, tumors need to have a blood supply to grow and proliferate. Cancerous cells are able to take control of the blood vessel network by releasing molecules that activate certain genes that make proteins encouraging growth of new blood vessels. These vessels supply the cancer cells with all the nutrients and oxygen necessary to proliferate.
Targeted therapies, unlike chemotherapy or immunotherapy, attack specific mechanisms that promote and encourage growth of cancerous cells. Many of these therapies block the proteins that create the blood vessels that feed the tumor. Since normal tissue already have an established blood supply, they are not affected by targeted therapy medication. There are three targeted therapies for people who have metastatic kidney cancer: sorafenib (Nexavar), sunitinib (Sutent), and temsirolimus (Torisel).
Both sorafenib and sutent, approved by the FDA in 2005 and 2006 respectively, have been found to shrink kidney tumors in patients who have already failed other treatments. Both therapies work by inhibiting VEGF (vascular endothelial growth factor) and platelet derived growth factor (PDGF), which stimulate blood vessels to grow into tumors.
Temsirolimus was FDA approved in 2007 and blocks mTOR, a substance that acts like a master switch in turning on mechanisms that promote growth of cancer cells. Side affects for all three targeted therapies are generally easy to treat.
