What are the treatments for kidney cancer ?
Personalized treatments
Cancer treatment is increasingly personalized, and each patient's case is discussed at a Multidisciplinary Concertation Meeting (MCM). This meeting includes at least an oncologist, a radiotherapist, and a urologic surgeon. A pathologist or a biologist may also be present to provide their opinion on specific cases.
Once a treatment plan is decided at the MTB, the doctor who will initially manage the disease, often an oncologist or a urologic surgeon, will explain the treatment or, more precisely, the proposed therapeutic course during a specific consultation known as the "announcement consultation".
The term "therapeutic course" is indeed appropriate as the patient will be offered a path that can sometimes be long and marked by several stages. During these stages, one or more of the five available cancer treatments will be used: two of these treatments are locoregional—surgery or radiotherapy. The other three treatments are systemic—chemotherapy, targeted therapy, or immunotherapy.
Surgery
The goal of kidney cancer surgery is to remove the primary tumor and the nearby lymph nodes. This surgery can vary in extent, from resecting a small part of the affected kidney (tumor resection or partial nephrectomy) to removing the entire kidney (total nephrectomy). Today, the most commonly used technique is partial nephrectomy, particularly for tumors smaller than 5 cm. This technique aims to preserve kidney function as much as possible. Surgical interventions can be performed either traditionally with an incision under the ribs or in the lower back (lumbar region) or via laparoscopy.
💡 DID YOU KNOW ?
This technique requires only small incisions. These incisions allow the insertion of a small camera into the abdomen to visualize the area to be operated on, as well as small instruments to remove the tumorous areas. Laparoscopy can also be performed using a robot. The robot controls four operating arms positioned above the patient.
The urologic surgeon views the organs in high definition (HD) and three dimensions (3D) and maneuvers the robotic arms with great precision to remove the targeted organs. Regardless of the technique used, the surgical procedure is performed under general or epidural anesthesia.
Laparoscopy is becoming more common because its effectiveness is comparable to traditional techniques but offers the advantage of smaller scars, reduced postoperative recovery, and shorter hospital stays.
Interventional radiology
Since the 2000s, another form of treatment has been interventional radiology. This minimally invasive, percutaneous approach is performed without general anesthesia and involves a hospital stay of 24 to 48 hours.
Under ultrasound or CT guidance, an interventional radiologist will place electrodes to heat the tumor to over 55°C (radiofrequency) or freeze it to -120°C (cryotherapy) to destroy it. Success rates for this type of intervention (no residual tumor at 5 years) exceed 90% without the need for radiotherapy or chemotherapy (source: Pr Jean-Michel Correas, Hôpital Necker, Paris).
Chemotherapy
Chemotherapy aims to kill rapidly dividing cells, such as cancer cells. However, kidney cancers are poorly responsive to the drugs used in chemotherapy, so these drugs are rarely used except in rare cases of Bellini carcinoma.
Targeted therapies
In contrast to chemotherapy, kidney cancers are responsive to so-called "targeted therapies".
Expert perspective
As their name suggests, targeted therapies are directed against targets that are directly involved in the transformation of normal cells into cancer cells or in the development of malignant tumors.
These targets can be located on the surface or inside cancer cells. On the surface, they might be specific receptors such as the Epidermal Growth Factor Receptor (EGFR). Internally, they could be molecules like RAS or mTOR, which are involved in intracellular pathways crucial for cancer cell proliferation. By blocking these targets with targeted therapy, tumor growth is directly inhibited.
Targets can also be located outside cancer cells. For example, the Vascular Endothelial Growth Factor ( VEGF ) binds to a receptor, VEGF-R , located on blood vessels. This growth factor and its receptor promote the development of new blood vessels around the tumor from existing vessels ( neo-angiogenesis ). These new vessels facilitate tumor growth by nourishing cancer cells and supporting their proliferation. By blocking VEGF or VEGF-R, tumor development is indirectly stopped.
Several targeted therapies against VEGF or VEGFR are used for the treatment of advanced and/or metastatic kidney cancers, either before (neoadjuvant treatment) or after (adjuvant treatment) surgical intervention. Other targeted therapies, specifically directed against mTOR, are also used, particularly in patients with advanced kidney cancer that has progressed under or after anti-VEGF or anti-VEGF-R targeted therapy.
Immunotherapy
Immunotherapies have been used for several decades to treat kidney cancers. These treatments aim to stimulate the immune system to eliminate cancer cells. Previously, immunotherapy for kidney cancers was performed with natural molecules such as interferon alpha or interleukin 2. Today, the immunotherapies used are checkpoint inhibitors.
Expert perspective
Le traitement de cancers par immunothérapie avec des inhibiteurs de point de contrôle est une véritable révolution dans le traitement de certains cancers dont les cancers du rein. Ces traitements sont basés sur les trois découvertes suivantes :
- the first discovery is the identification of specific molecules called checkpoints that can either accelerate or slow down the functioning of the immune system ;
- The second discovery is that cancer cells can exploit these checkpoints to evade the immune system. Specifically, they use a checkpoint known as CTLA-4 to slow down the immune response. CTLA-4 is found on certain white blood cells called helper T lymphocytes , which are essential for initiating an immune response. CTLA-4 inhibits the action of these lymphocytes. Another checkpoint is PD-L1 , which is present on the surface of cancer cells. This molecule binds to another molecule called PD-1 , located on the surface of different white blood cells, the cytotoxic T lymphocytes , which are responsible for eliminating cancer cells. The binding of PD-L1 to PD-1 prevents these lymphocytes from performing their role and eliminating tumor cells ;
- The third discovery is that drugs blocking the checkpoints CTLA-4, PD-1, or PD-L1 can reactivate the immune system to eliminate tumor cells. These drugs are classified as immunotherapies because they do not directly kill cancer cells like chemotherapy does but rather stimulate the immune system to attack and eliminate the cancer cells. These immunotherapies are often more effective if the cancer cells have a high number of PD-L1 molecules on their surface.
Checkpoint inhibitors against CTLA-4, PD-1, or PDL-1 are now used alone or in combinations to treat kidney cancers. Since kidney cancers are often resistant to radiotherapy, it is used only in cases of metastasis.
Clinical trials
Ultimately, the main treatments, surgery, targeted therapy, or immunotherapy, will be used depending on the stage of the disease. Combinations of these different treatments are the subject of numerous clinical trials, and the results of these trials are expected to bring new advances in the treatment of kidney cancers.
Discover ongoing clinical trials recruiting in France for kidney cancer
--
Article updated on Dec 26, 2024
Get a second opinion for your cancer from an expert
Response within 7 days