A study of nearly 1,500 patients treated for kidney cancer at UCLA in the past 15 years shows that an aggressive, tailored treatment approach results in better survival rates and uncovered subsets of kidney cancer that behave differently and need to be treated accordingly. The study appeared in the Nov 1, 2008, issue of Cancer.
The one-size-fits-all approach traditionally used in kidney cancer treatment should be changed based on the results of the study, the longest to date to analyze kidney cancer patients and their outcomes, said Arie Belldegrun, md, senior author of the study, a professor of urology at UCLA’s Jonsson Comprehensive Cancer Center.
“This is the most important work that we’ve done out of the kidney cancer program at UCLA,” Dr. Belldegrun said. “We outline the foundation for personalized kidney cancer therapy. We have shown that not all kidney cancer patients are the same, not all localized kidney cancers are the same and not all metastatic kidney cancers are the same.”
The study found that patients with localized kidney cancer could have either low-, intermediate-, or high-risk cancers based on the chance for recurrence. Patients with cancers that have already spread fell into similarly different subsets. Some have better outcomes, while others may have very aggressive cancers that may not warrant treatment.
“We showed for the first time, using an integrated staging system developed at UCLA, that we can identify which patients with localized disease fall into the low-, intermediate-, and high-risk subsets and which patients with metastasized cancers are either low-, intermediate-, or high-risk patients,” Belldegrun said. “Now we can make treatment decisions based on that.”
If a patient with localized cancer is identified as low-risk, his 5-year survival rate is expected to be 97%, while his 10-year survival rate is 92%. An intermediate-risk patient with localized disease would have a 5-year survival rate of 81% and a 10-year survival rate of 61%. A high-risk patient has a 5-year survival rate of 62%, with a 10-year survival of 41%.
“All of these patients with cancers that have not spread present to their doctors with presumably localized disease, and in the past they may have been treated the same way,” Belldegrun said. “They need to be treated individually according to their risk levels.”
The study showed that a patient with low-risk, localized kidney cancer could be treated only with surgery and expect an excellent outcome. Such a move would spare the patient from having to undergo radiation or immunotherapy. However, for a patient with high-risk, localized kidney cancer, surgery would not be enough. Additional therapy such as targeted treatments or immunotherapy should be considered in order to give the patient the best possible outcome.
Precise Identification for Therapy
In metastatic patients, someone with low-risk cancer should get very aggressive treatment, Belldegrun said, because there’s a good chance the therapy will help the patient. Those with high-risk, metastatic disease won’t get much, if any, benefit from treatment and may want to forego surgery and the toxic therapies.
“Our paper identifies, very precisely, which patients should get which therapies,” Belldegrun said.
The study represents 15 years of experience in UCLA’s kidney cancer program, an interdisciplinary approach to treating cancer that brings together medical oncologists, urologists, surgeons, clinical trials experts, and scientists under one roof, a concept that was first conceptualized at UCLA. The study analyzed the first 1,492 patients treated in the program and “demonstrated that outstanding results can be achieved using this approach,” Belldegrun said.
About 25% of the patients with metastatic kidney cancer achieved long-term responses—5- to 15-year survivals—from their therapy, Belldegrun said. Less than 5% of metastatic kidney cancer patient typically achieve long-term survivals or a cure when treated with conventional treatments.
“This is by far the best survival data in such a difficult group of patients,” Belldegrun said. “This can be achieved today only in kidney cancer centers of excellence like we are operating at UCLA, where we have all the expertise at hand, the best scientists, clinicians, and surgeons working together.”