Extending Lives of Patients with Advanced Kidney Cancer

Kim Irwin
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(310) 206-2805

Kambra McConnel
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(310) 206-3769

RESEARCHERS AT UCLA'S JONSSON CANCER CENTER SIGNFICANTLY EXTEND LIVES OF PATIENTS WITH ADVANCED KIDNEY CANCER

Aggressive surgery coupled with strong immunotherapy resulted in significantly increased survival times for a group of advanced kidney cancer patients for whom few other treatment options existed, according to researchers at UCLA's Jonsson Cancer Center.

The promising outcomes from this aggressive treatment regimen may change the way physicians treat advanced kidney cancer, said Dr. Arie Belldegrun, chief of the Division of Urologic Oncology at UCLA's Jonsson Cancer Center.

Belldegrun's findings, derived from studying 31 patients treated for advanced disease at the UCLA Kidney Cancer Program over a period of eight years, are revealed in the July issue of the Journal of Urology. The UCLA patients all had advanced kidney cancer that had spread to other parts of the body, such as the lung, liver and bones. The malignancy also invaded the inferior vena cava, the major vein leading to the heart.

Most of these patients, Belldegrun said, had few other treatment options. Many had been told they had less than six months to live when they sought help at the UCLA Kidney Cancer Program.

"This therapy is for patients who have no options left," Belldegrun said. "We followed a series of patients with the most complicated, advanced kidney cancers who underwent this treatment and found they have much brighter futures. We have patients that we've treated with this regimen who are now enjoying five- and six-year survivals."

Richard Katz, 74, of West Los Angeles, was told by two different physicians that there was little they could do to treat his kidney cancer. They advised him to wrap up his personal affairs. When diagnosed in 1991, Katz's cancer had spread to the lungs. When he came to UCLA in 1992, he had already tried several experimental treatments without success. CT scans showed his cancer was continuing to spread.

At UCLA, Katz's cancerous kidney was removed during a procedure called a nephrectomy. Following surgery, he underwent a rigorous course of immunotherapy -- a technique that prompts the body's immune system to recognize cancer as an invading enemy and destroy it. When Katz saw his UCLA oncologists after the treatment was completed, he was told his cancer was gone. Malignancies in his lungs that showed clearly on previous scans and X-rays could not be seen following the removal of his kidney and the course of immunotherapy.

"The X-rays were right in front of me and they were clear as a bell," said Katz, who's been married for 45 years. "I wept. I was out of control. Two doctors had told me to get my house in order and I had. Then the cancer was gone."

For the first five years following his treatment, Katz remained cancer free. In 1997, a spot appeared on his left lung and surgeons removed the malignancy. Last year, another lesion appeared and also was surgically removed. However, Katz hasn't had any further recurrences.

"I'm feeling very good," he said. "I know without this treatment I would be dead now. The cancer was spreading all over my lungs."

Henry Meinhardt, 66, a business owner from Upper Marlboro, Md., also believes his advanced kidney cancer would have killed him quickly had he not undergone the aggressive therapy regimen at UCLA.

Meinhardt's physician in Maryland told him his cancer was "too far gone" for surgery to do any good. Unwilling to give up, Meinhardt came to the UCLA Kidney Cancer Program in 1995 and underwent a nephrectomy and immunotherapy. He's been cancer free ever since. The malignancies that had spread to his lungs now show up only as tiny spots of scar tissue on scans and X-rays.

"I truly feel I've been reborn," said Meinhardt, who travels to UCLA once a year to be monitored for cancer. "Everything is good now. I feel normal."

Dr. Mike Manyak, who serves as chairman of the Technology Assessment Council for the American Urological Association, said he's encouraged by the results Belldegrun obtained using the aggressive treatment regimen.

"The take home message from this is that there may now be data to support an aggressive multi-modal approach for treatment of metastatic kidney cancer. In the past, we had no significant data to support aggressive therapy for these patients," said Manyak, who also is professor and chairman of the Department of Urology at George Washington University Medical Center in Washington, D.C. "This also supports the concept of nephrectomy as part of the treatment plan for kidney cancer that has metastasized. Further study with longer term follow up is warranted for this approach."

Dr. Robert Figlin, a kidney cancer specialist who worked with Belldegrun on the research, agrees that further investigation is necessary. However, he's confident these findings will prompt a change in the way kidney cancer patients are treated.

"Our early and pioneering work firmly suggests that nephrectomy, when combined with immunotherapy, offers patients improved outcomes over nephrectomy or immunotherapy alone," said Figlin, who also serves as director of the Clinical Research Unit at UCLA's Jonsson Cancer Center. "Although ultimate proof of this approach will require further investigation, we consider this to be the standard against which future therapies will be compared. All kidney cancer patients who do not receive care from experts in both immunotherapy and urologic oncology run the risk of receiving less than optimal care for this complex disease."

UCLA's new treatment regimen is possible in part because of advances in surgical techniques and improved immunotherapies, Belldegrun said. Still, surgery for advanced kidney cancer -- specifically when it invades the inferior vena cava -- is risky and complex, and usually is performed only at selected cancer centers, he said.

Many advanced kidney cancer patients are treated with immunotherapy alone. The trouble with that approach, Belldegrun said, is that the cancer generally overwhelms the immunotherapy in cases of advanced kidney disease -- there are just too many cancer cells for the patient's immune system to kill. In the UCLA treatment regimen described in the journal article, surgeons first remove as much of the cancer as possible, sometimes up to 90 percent. The immunotherapy then has a much better chance to succeed when it takes on the remaining cancer, Belldegrun said.

This aggressive surgery and immunotherapy technique has become the standard of care in the UCLA Kidney Cancer Program, Belldegrun said. The program employs a team approach to attacking the disease, bringing in experts such as surgeons, oncologists and radiologists to consult on each case. The patients who qualified for the aggressive treatment regimen have enjoyed extended survivals, Belldegrun said.

"In contrast to the poor results of surgery alone -- reasonable five-year survival rates can be obtained following a combination of aggressive surgery and immunotherapy," the Journal of Urology article concludes. "With careful planning and experienced immunotherapists, (this) therapy can be completed in a majority of this high risk group of patients."

Patients with metastasis limited to their lungs and who had less aggressive tumors enjoyed a better prognosis than patients whose cancer was more aggressive and had spread to other parts of the body such as the liver and the bones, Belldegrun said.

Historically, advanced kidney cancer has been a lethal disease, with less than 15 percent of patients surviving to the five-year mark. According to the American Cancer Society, more than 30,000 new cases of kidney cancer will be diagnosed this year, with about one-third resulting in death.

"This is the state-of-the-art treatment for patients with advanced, metastatic kidney cancer," Belldegrun said. "Under current conventional treatments, these patients would have had less than six months to live. With this regimen, we can give them more time, and for some, even complete remission."

-UCLA-

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