Cancer Treatment Today » Renal (Kidney) Cancer

Temodar for Kidney Cancer

M Levin, MD — Wed, 21 Nov 2012 19:53:01 +0000

Personalized medicine approach tests individual cancers and chooses treatments based on this testing. Temodar is one of the drugs that is usually included in chemosensitivity panels. Sometimes, it is recommended to renal cell cancer patients based on such testing. Unfortunately, this new paradigm does not “fit” well with the existing approaches and methods for weighing and evaluating evidence supporting cancer treatments, and new approaches to do so have not yet been developed.

Temodar has some supporting, albeit conflicting evidence in renal cancer, if you follow the “old” paradigm. One study found it have no activity in kidney cancer, whereas anotehr found it to have minimal side effects and a total response rate of 60%. Another study found no objective responses in a group of previosuly treated patients. Temozolamide. Another study found Temodar and interferon combined to be inactive.

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Cryoablation for kidney cancer

M Levin, MD — Wed, 12 Sep 2012 21:45:59 +0000

Cryoablation is not well supported by the medical literature for renal cell cancer. There are mostly case reports and series, although some of them are large and there are no comparative trials. The procedure has some theoretical disadvantages. For one, it leaves no pathology, so that prognostication becomes difficult. Other limitations of percutaneous cryoablation include the inability to control hemorrhage without intra-arterial access and a lack of long-term follow-up data. Perioperative complications and renal functional outcomes of laparoscopic cryoablation and open partial nephrectomy are similar; however, laparoscopic cryoablation confers a substantially higher local recurrence risk of about 15% after 3 years. There are no formal guidelines but some experts believe that laparoscopic renal cryoablation should be reserved for high risk patients with decreased life expectancy.

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Chromophobe (ChRCC) Type Renal Cell Cancer

M Levin, MD — Tue, 17 Jul 2012 14:36:00 +0000

The Chromophobe (ChRCC) type renal cell cancer is rare and behaves differently than the more common renal cell carcinoma. Consequently it has not been extensively studied. Unfortunately, there are no proven treatments for the metastatic disease and the many drugs that have been approved for clear cell cancer do not work well for this subtype. At one time chemotherapy was thought to be effective but studies did not confirm it. Overexpression of CD117 on cellular membranes of ChRCC could in the future be a potential target for kinase inhibitors like: imatinib, dasatinib, nilotinib. The potential targets for other kinase inhibitors (sunitinib and sorafenib) in ChRCC seem to be the well known VEGFR and PDGFR but, again, this has not been systematically studied. In conclusion, these observations are the basis for formulating research hypotheses which should be verified in prospective studies. In the meantime, a referral to a clinical trial is probably the best idea for a patient with chromophobe kidney cancer.