How has treatment improved for patients with kidney cancer in the last five years? New therapies or drugs available?
For smaller renal masses, we are seeing an increased use of renal mass biopsy and active surveillance strategies. Biopsy can better characterize lesions prior to intervention. In some cases, this can prevent the need for surgery and make patients and providers more comfortable with surveillance. There is also an indication for using immunotherapy drugs to treat patients at high risk of recurrence after surgery, whereas prior indications for use were in the metastatic setting only.
For tumors of the renal pelvis (central, urinary drainage region of the kidney), we are happy to offer patients JelMytoâ (Mitomycin gel) through the Prostate and Urologic Cancers Program at the Smilow Cancer Hospital Care Center in Waterford. This is the first site in the state to offer this treatment, which is predominantly indicated for patients with recurrent low-grade tumors. Options for these patients have historically been quite limited and sometimes led to removal of the entire kidney or ureter, some of which can likely be avoided with this agent, which is administered through an endoscopic procedure.
How has the use of minimally invasive techniques for managing kidney cancer benefited patients? Is there screening available?
The continued integration of advanced robotic surgical platforms in not only tertiary care, but also community hospitals, has been instrumental in ensuring patients get the best minimally invasive operations. For small renal masses and even some larger masses, this means partial nephrectomy (tumor removal while sparing healthy kidney) instead of radical nephrectomy. While there is no screening for kidney cancer in the general population, many renal masses are picked up incidentally on abdominal imaging done for other reasons.
Can you talk about the role of multidisciplinary care in the treatment of kidney cancer? Who is involved?
As with many cancers, multidisciplinary care for kidney cancer is important. While many early-stage cancers can be managed by a urologist alone, advanced renal cell cancers and most upper tract urothelial cancers likely benefit from a multidisciplinary approach. This involves input from radiology, interventional radiology, urology, medical oncology, and occasionally radiation oncology as well. At the Smilow Cancer Hospital Care Center in Waterford, we have been running a monthly multidisciplinary clinic for the past 3 years which focuses on complex urologic cases.
What role do clinical trials play in the advancement of treatment for kidney cancer and why is it important to provide access to all patients?
Clinical trials in general are crucial for furthering the medical knowledge of a given condition or treatment. In kidney cancer, research has recently focused on expanding the use and introduction of immunotherapy to early-stage cancers with the hope of preventing progression or recurrence. There is also quite a bit of research interest in better imaging/diagnostics to identify tumor subtypes prior to intervention. Patients interested in clinical trials can check out ClinicalTrials.gov or speak to their urologist/oncologist about what is available in their area.