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What Is The Best Treatment For Renal Cell Carcinoma

When To Get Medical Advice

Best agents for 2nd line and treatment of metastatic clear cell renal cell carcinoma

See a GP if you have symptoms of kidney cancer.

Although itâs unlikely you have cancer, itâs important to get your symptoms checked out.

The GP will ask about your symptoms and may test a sample of your urine to see if it contains blood or an infection.

If necessary, they may refer you to a hospital specialist for further tests to find out what the problem is.

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What Is The Prognosis For People With Ccrcc

The estimate of how a disease will affect you long-term is called prognosis. Every person is different and prognosis will depend on many factors, such as

  • Where the tumor is in your body
  • If the cancer has spread to other parts of your body
  • How much of the tumor was taken out during surgery

If you want information on your prognosis, it is important to talk to your doctor. NCI also has resources to help you understand cancer prognosis.

Doctors estimate ccRCC survival rates by how groups of people with ccRCC have done in the past. Because there are so few pediatric ccRCC patients, these rates may not be very accurate. They also dont take into account newer treatments being developed.

With this in mind, ccRCC patients with smaller tumors have a better chance of survival than patients with larger tumors. The 5-year survival rate for patients with ccRCC is 50-69%. When ccRCC is already large or has spread to other parts of the body, treatment is more difficult and the 5-year survival rate is about 10%.

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What Is The Best Treatment For Renal Cell Carcinoma

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Determining The Best Treatment For Renal Cell Carcinoma In Young Patients

Karakiewicz and colleagues have demonstrated that age at diagnosis appears to be an independent prognostic factor for cancer-specific survival in patients with renal cell carcinoma , confirming findings reported by other investigators. Unlike other sites such as the colon and prostate, younger patients presenting with RCC appear to have a better prognosis than older patients. Although one must interpret the results of retrospective studies with caution , the data seem compelling. This survival benefit suggests that an age-tailored approach to managing RCC is important. Given the favourable survival data for younger patients, the importance of nephron-sparing surgery increases, even in cases where it may not be imperative. This is particularly true when combined with data suggesting that long-term renal function is superior following nephron-sparing surgery and cancer-specific survival is equivalent to open surgery. Although partial nephrectomy remains the gold standard form of nephron-sparing surgery, the role for other renal ablative technologies such as radio-frequency ablation, cryotherapy, high-intensity focused ultrasound and the Gamma Knife remains to be defined particularly in the treatment of the disease in younger patients. Minimizing patient morbidity while maximizing survival and long-term cure rates is important to all patients, but it is doubly important in younger patients.

What Are The Types Of Renal Cell Carcinoma Treatment Options Available

Renal Cell Carcinoma A New Standard Of Care

After renal cell cancer has been diagnosed, tests are done to find out if cancer cells have spread within the kidney or to other parts of the body before choosing the suitable treatment. There are five types of standard treatments for Renal Cell Carcinoma that are used:2

  • Surgery to remove part or all of the kidney is often used to treat renal cell cancer.
  • Radiation therapy that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
  • Chemotherapy that uses medicines to stop the growth of cancer cells.
  • Immunotherapy that uses the patient’s immune system to fight cancer via substances made by the body or made in a laboratory.
  • Targeted therapy that uses medicines to identify and attack specific cancer cells without harming normal cells.

For a more detailed explanation of the possible RCC treatment options, please visit the cancer.gov website here.

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Treatment Of Stage Iv And Recurrent Renal Cell Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Thinking About Taking Part In A Clinical Trial

Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.

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Help Getting Through Cancer Treatment

People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.

Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.

Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.

The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.

Renal Cell Carcinoma Treatment: Whats New And What’s Next

What is the best second-line treatment of advanced renal cell carcinoma (RCC)?

Renal cell carcinoma is the most common type of kidney cancer. Most treatments are focused on clear cell carcinoma, which is the most common subtype of this disease.

Often, patients who are diagnosed with renal cell carcinoma when it is in its earliest stages can be successfully treated. But what are the treatment options for early-stage disease as well as renal cell carcinoma that has spread to other parts of the body? How do you know which treatment is right for you?

Heres what to know about current treatment options and new approaches being explored through clinical trials.

Active surveillance for renal cell carcinoma

If renal cell carcinoma is growing slowly, active surveillance may be an option, says Pavlos Msaouel, M.D., Ph.D. Patients under active surveillance will have checkups every few months and undergo imaging exams to see if the tumor is growing or spreading.

Some patients may be hesitant to choose this option, in fear of cancer spreading unchecked. But Msaouel says regular checkups generally make active surveillance a safe option.

Surgery, targeted therapy and immunotherapy could be options if the cancer advances, depending on your specific diagnosis.

Surgery is an option when renal cell carcinoma hasnt spread

Surgery to remove the affected kidney offers the highest chance for successful treatment when cancer hasnt spread.

Your kidneys filter blood and waste in our bodies and help produce urine. Since we have two kidneys, its possible to live with one.

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Complementary And Alternative Medicine

There are no alternative methods that have been shown to cure kidney cancer, but some approaches may help ease the side effects of treatment or the cancer itself.

Common complementary and alternative medicine therapies may include:

  • Massage
  • Acupuncture
  • Art therapy

Additionally, patients with advanced kidney cancer may benefit from palliative care, an approach that uses different strategies to lessen pain and make you more comfortable. Talk to your oncologist or other healthcare provider if you’re interested in learning more about these treatments.

Drugs That Target Tumor Blood Vessel Growth

Sunitinib

Sunitinib acts by blocking both angiogenesis and growth-stimulating proteins in the cancer cell itself. Sunitinib does this by blocking several tyrosine kinases that are important for cell growth and survival. This drug is taken as a pill daily, typically for 4 weeks on and 2 weeks off. Some doctors might recommend taking it 2 weeks on and 1 week off to reduce side effects.

Sunitinib can be used in people with advanced kidney cancer, as well as in people with a high risk of the cancer returning after surgery, to help lower the risk that the cancer will come back. This is known as adjuvant therapy.

The most common side effects are nausea, diarrhea, changes in skin or hair color, mouth sores, weakness, and low white and red blood cell counts. Other possible effects include tiredness, high blood pressure, congestive heart failure, bleeding, hand-foot syndrome, and low thyroid hormone levels.

Sorafenib

Sorafenib blocks several tyrosine kinases, similar to the ones blocked by sunitinib. It attacks both blood vessel growth and other targets that help cancer cells grow. It is taken as a pill twice a day.

The most common side effects seen with this drug include fatigue, rash, diarrhea, increases in blood pressure, and redness, pain, swelling, or blisters on the palms of the hands or soles of the feet .

Pazopanib

Cabozantinib

Cabozantinib is a drug that blocks several tyrosine kinases, including some that help form new blood vessels.

Lenvatinib

Bevacizumab

Axitinib

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Signs Of Renal Cell Cancer Include Blood In The Urine And A Lump In The Abdomen

These and other signs and symptoms may be caused by renal cell cancer or by other conditions. There may be no signs or symptoms in the early stages. Signs and symptoms may appear as the tumor grows. Check with your doctor if you have any of the following:

  • Blood in the urine.
  • A lump in the abdomen.
  • A pain in the side that doesn’t go away.

The Heterogeneity Of Renal Tumor

Towards individualized therapy for metastatic renal cell ...

Zinc-finger and homeobox protein 2 is a VHL target. VHL loss-of-function mutations usually result in an increased abundance and nuclear localization of ZHX2. Loss of ZHX2 inhibits signaling through the transcription factor NF-B, and ZHX2 binds to many NF-B target genes, revealing that ZHX2 is a potential therapeutic target for RCC .

VHL inactivation alone is insufficient for RCC tumorigenesis, and several gene mutations contribute to tumor heterogeneity that characterizes RCC. Intratumoral heterogeneity, defined as the presence of genetically different clones in different subpopulations of the same tumor, is a typical renal tumor condition . Accordingly, phylogenetic studies show how the tumorigenesis in the RCC follows an evolutionary model, tree-like: in the trunk lies the main mutation that paves the way for tumorigenesis, and from the trunk, different subclonal mutations branch out, which contribute to tumor growth and progression. Data from the TRACERx renal study have identified secondary mutations and chromosomal changes involved in tumor evolution .

In addition to proper genetic damage, we must consider the variations induced by the environment , alterations in receptor expression, and all the complexity that revolves around the tumor microenvironment.

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Role Of Surgery In The Advanced Setting

Cytoreductive nephrectomy

The importance of nephrectomy in metastatic disease has been demonstrated in historical series,, including 2 randomized trials that demonstrated an OS advantage, conducted in the cytokine era. In the Southwest Oncology Group trial of 246 patients with mRCC of any histology who received treatment with IFN-α, the addition of cytoreductive nephrectomy improved OS from 8 to 11 months. Similarly, a smaller European study reported by Mickisch et al on behalf of the European Organization for Research and Treatment of Cancer assigned 83 patients with mRCC to either combined CN and IFN or IFN alone. In that study, the addition of CN more than doubled the median OS from 7 to 17 months in favor of the group of patients allocated to the combination strategy.

Conversely, in the contemporary era of targeted therapy, there has been a decreasing utilization rate of CN, probably because of the absence of contemporary randomized studies., Of note, there are several retrospective analyses, available and a recent systematic review and meta-analysis, including 12 articles with almost 40,000 patients, has identified an OS benefit for patients who undergo CN. At the same time, some patients do poorly after surgery, and some factors like poor-risk group , poor performance status , liver metastasis, or retroperitoneal or supradiaphragmatic adenopathies have been associated with poor outcomes and might help with patient selection.,

Surgical resection of metastatic disease

Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

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Role Of Tumor Nephrectomy In Patients With Synchronous Metastases

The impact of tumor nephrectomy is subject to debate for patients with RCC with synchronous metastases. With regard to immunotherapy, two randomized trials have demonstrated a survival benefit for patients undergoing nephrectomy and immunotherapy compared with immunotherapy alone . Correspondingly, of the patients enrolled in phase 3 trials with targeted drugs, approximately 90% previously underwent nephrectomy. Data from the sunitinib expanded access program of mRCC suggest that patients with prior nephrectomy treated with sunitinib have a better outcome with regard to objective remission rates, PFS and OS . Similar data have been obtained in the sorafenib EAP. Thus, tumor nephrectomy prior to the initiation of tyrosine kinase inhibitor therapy remains the standard of care also in patients with synchronous metastases. However, the positive impact of tumor nephrectomy may be limited to patients with low- and intermediate-risk disease since no benefit was found for high-risk patients in a subgroup analysis of the Phase III temsirolimus study.

How Therapeutic Algorithm Has Changed In Mrcc Treatment With The Approval Of Combo

Treatment of Metastatic Non-Clear Cell Renal Cell Carcinoma

For a decade, it has been wondered what the best sequence treatment between TKImTORiTKI vs TKITKImTORi is. However, the next future question will be much more complex since there are no comparative studies, clear prognostic factors, or predictive markers, thus making a weighted choice between the various options available in the first- and second-line very difficult.

The new treatment strategies range from molecular targeted agents such as cabozantinib, able to overcome some anti-angiogenic mechanisms of resistance, through ICIs, such as nivolumab, as a single agent, up to the combinations of ICIs , or between ICIs with VEGF-targeting agents .

The paradigm of first-line treatment in advanced RCC, firmly occupied for more than 10 years by monotherapy with anti-angiogenic TKIs, such as sunitinib or pazopanib, has changed, and combinations of ICIs, either with each other or with TKIs, have shown efficacy compared to monotherapy with TKIs. In light of the results of recent combinations, except for comorbidity and clinical contraindications, in the first-line, the therapeutic proposal is to administer all prognostic classes the combination TKI/IO or IO/IO , and considering the combination IO/IO for patients with sarcomatoid components, whereas all other cases remain valid for TKI monotherapy, in particular, cabozantinib in the intermediate- and high-risk subgroups unfit for combo treatment, and pazopanib or sunitinib in the good risk unfit for combo .

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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Radicaland Partial Nephrectomy Techniques

7.1.3.1.Radical nephrectomy techniques

No RCTs have assessed the oncological outcomes of laparoscopic vs. open RN.A cohort study and retrospective database reviews areavailable, mostly of low methodological quality, showing similar oncological outcomes evenfor higher stage disease and locally more advanced tumours . Based on a systematic review, less morbidity wasfound for laparoscopic vs. open RN .

Data from one RCT and twonon-randomised studies showed asignificantly shorter hospital stay and lower analgesic requirement for the laparoscopic RNgroup as compared with the open group. Convalescence time was also significantly shorter . No difference in the number of patients receiving bloodtransfusions was observed, but peri-operative blood loss was significantly less in thelaparoscopic arm in all 3 studies . Surgical complication rates werelow with very wide confidence intervals. There was no difference in complications, butoperation time was significantly shorter in the open nephrectomy arm. Post-operative QoLscores were similar .

7.1.3.2.Partial nephrectomy techniques

7.1.3.2.1.Open versus laparoscopicapproach
7.1.3.2.2.Open versus robotic approach
7.1.3.2.3.Open versus hand-assistedapproach
7.1.3.2.4.Open versus laparoscopic versusrobotic approaches
7.1.3.2.5.Laparoscopic versus roboticapproach
7.1.3.2.6.Surgical volume

7.1.3.3.Positive surgical margins onhistopathological specimens

Summary of evidence

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