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Dr. McDermott: Not that we know of. Certain factors are associated with increased risk of kidney cancer that can be avoided, such as smoking. Avoiding some environmental exposures will decrease your risk of getting cancer, but not eliminate it.
Dr. McDermott: Not at the current time. While there is not an effective screening test for kidney cancer, we're working hard to develop a blood or urine test that might detect this cancer at an early stage. But that work is still in its infancy. Kidney cancer is not common enough to make routine scanning with ultrasound and CT scans a reliable way of detecting the disease. Patients with a strong family history of kidney cancer should be seen in a clinic that specializes in hereditary Renal Cell Carcinoma (RCC) syndromes. Screening procedures can be recommended based on your potential risk of developing kidney cancer once you and your family have been completely evaluated. This would then lead to regular scans.
Dr. McDermott: The type of doctor depends on the stage of your kidney cancer. Once a cancer is detected, patients are often referred to a urologist for surgery. More commonly, patients are now being referred to medical oncologists to consider treatment after surgery to prevent recurrence of disease in the setting of clinical trials.
Dr. McDermott: If your risk of recurrence after surgery is low, you can often be followed by your urologist or primary care physician. However, to get an assessment of your risk of recurrence, it is often advisable to consult a medical oncologist who can help you develop a plan for cancer surveillance.
Dr. McDermott: At the current time there is no treatment that can be given after surgery that will reliably reduce the risk of cancer recurrence. However, a vast majority of patients with small tumors are cured with surgery alone. There are clinical trials that are studying the use of several new drugs that have been effective in patients with advanced kidney cancer that may be effective for patients with an earlier stage of this disease.
Dr. McDermott: In general, chemotherapy is less effective against kidney cancer than it is in other tumors. That being said, there are certain subtypes of kidney cancer for which chemotherapy may represent more effective therapy. This is being explored in clinical trials.
Dr. McDermott: In general, kidney cancer is relatively resistant to radiation therapy. This does not mean it should not be offered, as it can be effective in reducing the size of individual tumors and the symptoms associated with them (e.g pain, bleeding).
Dr. McDermott: Unlike breast and colon cancer, where treatment can be given after surgery (e.g. chemo, radiation, hormonal therapy) to reduce the risk of recurrence, there is no such proven adjuvant treatment for kidney cancer patients. There are, however, several clinical trials that are studying the effectiveness of targeted therapy (e.g. sunitinib, sorafenib) at reducing the risk of recurrence after surgery.
Dr. McDermott: HD IL2 treatment is one of the more toxic substances that is given to patients with cancer. It produces a wide variety of side effects that can lead to significant strain on most of the organs in the body and, in rare cases, to death. Therefore, patients need to be carefully monitored in the hospital when undergoing this treatment to help manage these serious, but reversible, side effects.
Dr. McDermott: Treatment algorithms are often developed to guide oncologists in managing the typical patient with advanced kidney cancer. However, not every patient is the same and many require treatment tailored to their particular situation. Also, the number of treatments that are available to patients with kidney cancer has been growing rapidly in the last several years, and this makes rigid therapy guidelines hard to develop.
Dr. McDermott: Adjuvant treatment is therapy given following surgery on a tumor in order to decrease the risk of the reoccurrence with that tumor. Examples include chemo, radiation, and hormonal therapy.
Dr. McDermott: At the current time, there are no other immunological therapies for kidney cancer. However, there are several encouraging targeted immunotherapies (e.g. CTLA4 antibody, PD1 antibody) that are in clinical trials for kidney cancer patients. We hope they will offer an improved anti-tumor effect with fewer side effects than cytokine therapy.
Dr. McDermott: They both come from a similar family of medications called cytokines. They are similar to natural substances that we have in our bodies to help us combat infection. They can be made in the laboratory, and then given back to people with a variety of conditions to help boost their immune response. While some of the side affects associated with these drugs are similar, HD IL2 is often given at much larger doses than interferon and therefore its side effects are significantly greater.
Dr. McDermott: HD IL2 is certainly not for every patient. Targeted molecular therapy has a broader application. Patients with multiple medical problems or non-clear cell kidney cancer should not receive HD IL2. However, for patients who are in good physical condition, and who have a favorable type of kidney cancer, HD IL2 may offer a small chance at a durable remission of their cancer. While targeted therapy can work well following HD IL2, the opposite might not be true. Therefore, we encourage patients who want to consider IL2 to discuss it with their oncologist prior to embarking on a course of targeted therapy.
Dr. McDermott: IL2 is certainly not for every patient, and its limitations are well documented. However, if one's goal is to achieve a durable remission of their cancer off-therapy, then IL2 is currently the only FDA approved therapy that offers this opportunity. Furthermore, it likely works even less well in patients who have failed prior therapies, therefore it's worth considering early on in the treatment of stage IV kidney cancer. While the targeted agents are much more likely to control the spread of your kidney cancer, their effect often wears off within a year of treatment and the benefit is not sustained if treatment is stopped.
Dr. McDermott: In general, patients should remain on a molecular targeted agent as long as they tolerate it reasonably well, and it is controlling the growth of their disease. In general, we follow patients every 3 months with scans while they're on these therapies unless they develop new symptoms.
Dr. McDermott: Absolutely. There is growing evidence that second and third line treatments can prolong the clinical benefit of targeted therapy. For example, recent evidence suggests that TOR inhibitors (e.g. everolimus) show some clinical benefit following failure of sunitinib and sorafenib. There are quite a few ongoing clinical trials looking at new therapies and combination therapies for patients who have failed prior treatment. It's important for patients to realize that if they want to be considered for these trials, they should ask about them after one treatment has failed — because it they've received too many prior treatments, they may not be eligible for clinical trials.
Dr. McDermott: We certainly hope so. This has been the case in several other cancer types (e.g. breast cancer, colon cancer). There are many clinical trials currently ongoing that look at the value of combination therapy both in treated and previously untreated patients. While the earlier results of these trials are encouraging, more work certainly needs to be done in this area before combination therapy becomes the standard of care.
Dr. McDermott: After you and your oncologist have reviewed the information on the effectiveness and toxicity of the current therapies available to patients with kidney cancer, it is never harmful to ask about the role of clinical trials. While clinical trials are not for every patient, they do offer the potential opportunity for improved outcomes for both untreated and previously treated patients. To learn about clinical trials in your region, you can go to ClinicalTrials.gov for a fairly comprehensive list of clinical trials for which you may be eligible.