The prognosis made in uncovering the genetic basis of renal cell carcinoma, its molecular pathways and the approval of novel therapies to perturb those pathways over the last decade is remarkable. Concurrently, stage IV kidney cancer response rates have increased with a near doubling of cancer-specific survival. Forward-looking, it is anticipated that kidney cancer will soon become a chronic disorder as we learn better to understand the biologic heterogenicity and a synergistic multimodal approach.
Approximately 30-40% of all patients will have metastatic or advanced kidney cancer. Recommended treatment for these patients is multimodal therapy. This type of treatment includes surgery, which is usually before systemic treatment. Approximately one-third of patients initially diagnosed with kidney cancer will present with distant metastasis. An additional 40% of patients that present with the localized disease will ultimately develop metastatic disease.
The biology of this cancer is unique and variable, and patients need personalized treatment. The problem is although several active agents exist for metastatic kidney cancer, they are considered non-curative for the majority of patients and thus require chronic therapy. Therefore, the benefits must be studied against the toxicity time commitment of cost. Due to the success in treating other solid tumors, chemotherapy for kidney cancer has been studied extensively during the last four decades. Unfortunately, the overall response rate is only 5.5% in some studies. The problem overall has been in the prior chemotherapy treatments of metastatic. The good news is new molecular testing and treatments are available now.
New predictive biomarkers are changing the treatment of stage 4 kidney cancer. We are now able to evaluate the molecular characteristics of tumors to treat with new targeted therapies unique to each patient. There will be 72 different genes or “biomarkers' 'tests, which are unique to each patient. These include pathways such as vascular endothelial growth factor (VEGF). Testing for and using targeted therapies is extremely important in Kidney cancer evaluation and treatment. The reason being is that these cancers have very high vascularity with new blood vessel growth. Chemosensitivity testing is essential to evaluate the most effective chemotherapy in treating your cancer. Examinations performed for natural substances, with tumor mutational burden and microsatellite instability, to assess the effectiveness of Immunotherapy with new checkpoint inhibitors. Evaluation of the patient’s immunity is of critical importance.
Combination therapy works best. Based on testing low-dose metronomic chemotherapy results in no or minimal side effects. High dose traditional maximum tolerated does chemotherapy can cause increased toxicity and immune suppression. Also, after testing, natural substances are instituted, which will elevate immune function and decrease chemotherapy resistance. They are all nontoxic.
The recent approval of Immunotherapy with checkpoint inhibitors and their combinations has changed the management and treatment of advanced kidney cancer. Anti-PD–1, anti-PD–L1, and CTL A–4 checkpoint inhibitors are currently used as first line treatments in these patients. The above treatments are used along with receptor tyrosine kinase inhibitors. The integration is now essential for patients with kidney cancer. They are synergistic with other treatments.
Vaccines currently can get extracted from your kidney cancer. Autologous whole tumor vaccines, dendritic cell vaccines can be produced in the laboratory and then reinjected back to kill your cancer. Your underlying immune function is evaluated and optimized. These tests are administered several times per year as needed.
Through new molecular testing, we can now evaluate your genetic biomarkers and your drivers that are causing your cancer. These are unique to each patient, and these pathways can be blocked. Also, we use low dose chemotherapy and natural substances after extensive testing. We will incorporate in your personalized protocol Immunotherapy with checkpoint inhibitors, autologous whole cancer vaccines, dendritic cell vaccine, and supportive oligonucleotides (SOT).
If you would like more information on stage IV kidney cancers or other cancers, please call us at 480-860-2030.