Kidney Cancer: Treatments

Kidney cancer is treated in the following ways
• Surgery
• Immunotherapy
• Targeted therapy
• Radiation therapy

Surgery

Kidney surgery to remove the primary kidney tumor is one of the main treatments for kidney cancers both if patients have cancer confined to the kidney or if the cancer has spread to other sites. Removal of the primary kidney tumor can be done in a number of ways. An open radical nephrectomy is the traditional approach to kidney surgery. During this operation, the entire kidney bearing the tumor is removed through a large incision in the flank. A partial or kidney-sparing nephrectomy is an operation that can be effective for treating small kidney tumors (less than 4 cm) not located at the center of the kidney. During a partial nephrectomy, the surgeon removes the tumor and a small margin of normal tissue around it, thus only removing the part of the kidney affected by tumor and allowing healthy tissue to remain.

More recently, laparoscopic surgeries to remove kidney tumors have been possible. In these minimally invasive operations three or four small incisions are made, through which surgical instruments and a camera can be placed. Using techniques developed at Columbia University, surgeons can perform a radical or partial nephrectomy laparoscopically. Patients who undergo minimally invasive surgery often have significantly less pain, less blood loss, cosmetically acceptable smaller incisions, a shorter hospital stay, and more rapid recovery when compared with open surgery.

Operations to remove kidney cancer, especially those done with a minimally invasive approach, can be technically challenging, and the expertise, experience, and planning of the surgeon can affect the outcome of the surgery. Doctors at The Herbert Irving Comprehensive Cancer Center have been at the forefront in advancing surgical techniques for kidney cancers for decades. For example, technically complicated surgeries where tumors are close vital structures such as the vena cava, the main vein leading into the heart, is done in collaboration with New York-Presbyterian heart surgeons to remove the cancer.

Cryotherapy

Cryotherapy (also called cryoablation) is a promising new minimally invasive technique that may be used to treat small kidney tumors (less than 4cm). During the procedure, a needle is placed into the center of the tumor. The needle is then brought to very low temperatures, freezing and destroying the kidney cancer cells. The surrounding tissue is monitored to allow preservation of the healthy kidney tissue.

Immunotherapy

Metastatic kidney cancers are one of the few cancers that are generally resistant to traditional chemotherapy and radiation. However, they are also one of the few cancers that may respond to immunotherapy, specifically to high dose interleukin-2 (HD IL2) therapy. IL-2 is a molecule made by a person’s immune system during infections to help the body attack bacteria and viruses. When given by doctors in high doses, a patient’s own immune system can be activated to attack their cancer. For some patients this therapy can completely eliminate the cancer from their bodies leading to what is termed a “durable long-term remission.” Because it is a complicated regimen that can be difficult to tolerate, only certain patients are eligible for this therapy. Furthermore, only certain centers in the United States have the physicians with the experience and the staff with the expertise equipped to handle this type of treatment. The Herbert Irving Comprehensive Cancer Center at NYP/CUMC has been treating patients with HD IL2 for over ten years and is the only academic, comprehensive high dose IL2 center in New York City.

Targeted Therapy

For patients with advanced kidney cancer who are not candidates for immunotherapy, or for those where immunotherapy is ineffective, three classes of drugs are currently available for targeted therapy. The first class of drugs is the tyrosine kinase inhibitors (TKIs), which include sunitinib (Sutent), pazopanib (Votrient), axitinib (Inlyta), and sorafenib (Nexavar). These are medications that can be taken by mouth and enter cancer cells to block growth signals that occur through the vascular endothelial growth factor (VEGF) pathway. Bevacizumab is an intravenous medication that inactivates the VEGF molecule, thus blocking the same growth signal to cancer cells. The third class of drugs is the mTOR inhibitors, which includes temsirolimus (Torisel) and everolimus (Afinitor). These medications block the mTOR pathway, another signaling pathway that stimulates kidney cancer cells to grow. These three classes of drugs have been shown to be effective in halting the growth or even reducing the size of tumors, allowing for cancer control and an improved quality of life. However, these medications, like many drugs used to target cancer, are specialized with specific and unique side effects that require close monitoring by specialists in the field. Doctors at the Herbert Irving Comprehensive Cancer Center have had years of experience with these drugs to provide personalized individual care.

Radiation Therapy

With advanced radiation therapy techniques doctors can better target tumors while reducing the radiation to nearby healthy tissues. Here at HICCC our radiation oncology experts have the ability to provide “state of the art” treatments for renal disease.

Your radiation oncologist will design the optimal treatment plan for you with you that will provide you the best optimal results. Treatment delivery can be daily, weekly, every other day, and or single fraction.

If radiation treatment is recommended, a radiation oncologist will work with our radiation oncology team to create a course of treatment. At Columbia University Irving Medical Center treatment modalities available and most commonly used for this cancer are External Beam Radiation Therapy, 3D Conformal Radiotherapy, Intensity Modulated Radiation Therapy (IMRT), Image Guided Radiation Therapy, Intraoperative Radiation Therapy (IORT) and Gamma Knife.