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'Watch and wait' might be better in advanced kidney cancer

Cautious approach could reduce reliance on toxic drugs with substantial side effects

Mark Gould

Thursday, 04 August 2016

Some adults with advanced, but slow-growing, kidney cancer can live for months and even years without the disease getting worse with active surveillance, or close monitoring, instead of having to undergo treatment with highly toxic anticancer drugs, suggests new research* published in The Lancet Oncology.

Every year in the UK there are some 11,870 new cases and 4,421 deaths from the disease. Survival varies widely from just five months in poor-prognosis patients without systemic treatment, to 43 months in patients with a good-prognosis who have systemic therapy.

When the cancer has spread to other parts of the body, the goal of systemic treatment is to slow the cancer down with drugs like sunitinib and sorafenib, designed to prevent the formation of new blood vessels, thereby stopping or slowing the growth or spread of tumours. But these treatments are expensive, not curative, and have serious side effects including increasing the risk of stroke and heart attack.

Some people with advanced kidney cancer have very slow-growing disease, and small case studies suggest that active monitoring and delayed treatment could be a safe, effective alternative to immediate systemic treatment, without compromising response to subsequent therapy.

The lead author of the new study, professor Brian Rini from Taussig Cancer Institute, Ohio in the USA, urges caution due to the small sample of just 52 patients studied, but his research reveals that a watch-and-wait approach was most successful in adults with limited metastases and those with one or less unfavourable prognostic factors such as anaemia, thrombocytosis, and greater disability.

For example, the 29 patients who had two or less organs affected and one or no risk factors at the start of the study remained on average almost three times longer on active surveillance than the other patients (22.2 months vs 8.4 months).

Importantly, quality of life, and anxiety and depression scores did not change substantially over the surveillance period, suggesting that living with untreated cancer did not cause psychological harm to patients with advanced kidney cancer in this study.

“There is a perception that all cancers should be treated immediately because they are equally lethal. But what we’ve seen in this small phase 2 study is that a subset of adults with advanced kidney cancer have slow-growing disease that can be safely managed using active surveillance, which could spare them the inconvenience and debilitating side effects of aggressive treatments for about a year, and in some cases several years, without worsening anxiety and depression”, Prof Rini said.


 * Rini BI, et al. Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. The Lancet Oncology, online first 2016. DOI: 10.1016/S1470-2045(16)30196-6

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