Dana-Farber / Brigham and Women's Cancer Center

Advances in Kidney Cancer Treatment and Onco-Nephrology

innovative treatment approaches for patients with kidney cancer and kidney complications from cancer treatment.

Specialists at Dana-Farber/Brigham and Women's Cancer Center are introducing numerous innovative treatment approaches for patients with kidney cancer and kidney complications from cancer treatment.

Targeted Therapies for Advanced Kidney Cancer

Toni K. Choueiri, MD, Director of the Kidney Cancer Center within the Center for Genitourinary Oncology, is the Principal Investigator for several trials for patients with advanced renal cell carcinoma (RCC), including:

  • A trial for patients with metastatic RCC who have not responded to prior targeted therapies is evaluating the role of novel immunotherapy in this disease (PD1 and PDL1 inhibition)
  • Combination therapies evaluating VEGF and upstream of MTOR (such as PI3-kinase) inhibitors to assess whether they are more tolerable and efficient than using VEGF and downstream MTOR inhibitors;
  • Upcoming trials and studies – including adjuvant therapy to prevent recurrences, non-clear cell RCC, and evaluation of a novel approach to RCC based on tumor genetics.

For further information regarding these trials, please call David Flanagan at (617) 582-8313.

Specialists and researchers in the Center also are developing new ways to determine which patients will respond to specific therapies. In resected kidney cancer, researchers are looking at molecular signatures and single nucleotide polymorphisms (SNPs) to predict which patients are at higher risk of recurrence. In conjunction with the Harvard School of Public Health, researchers in the Center also are investigating risk factors for RCC.

Focusing on Kidney Complications from Cancer Treatment
Directed by Benjamin D. Humphreys, MD, PhD, the Onco-Nephrology Program – a collaboration between the Division of Renal Medicine at Brigham and Women’s Hospital and Dana-Farber/Brigham and Women's Cancer Center – provides expert care for patients who develop renal complications as a result of cancer treatment.

"As patients live longer through effective cancer treatment, management of kidney toxicity is an increasing challenge," said Dr. Humphreys.

Program specialists care for patients undergoing hematopoietic stem cell transplantation, who are susceptible to acute kidney injury, pre-transplant electrolyte disorders, chronic kidney disease, and glomerular diseases, as well as patients taking chemotherapy, VEGF inhibitors, and other targeted therapies that induce hypertension and proteinuria.

Hypertension from VEGF therapies can often occur rapidly, requiring close management. A translational study at Brigham and Women’s Hospital ("Mechanism of Hypertension and Proteinuria Induced by Anti-VEGF Therapies"), led by Dr. Humphreys, is investigating why patients taking anti-VEGF targeted therapies frequently develop hypertension and proteinuria, specifically examining the impact of the blockade of endothelial nitric oxide synthase and stimulation of endothelin-1 activity. This research incorporates a tissue bank to study urinary biomarkers in patients taking VEGF inhibitor drugs to identify which patients are more likely to develop kidney complications.

These studies will ultimately help clinicians to better diagnose and manage the toxicities of targeted therapies, and most importantly may identify new biomarkers that could predict which patients are most likely to benefit from anti-VEGF therapies. This form of personalized medicine could have a great impact on kidney cancer outcomes. In addition, an upcoming trial of a novel anti-hypertensive medication for cancer patients with therapy-induced hypertension will open later this year.

Dr. Humphreys also works as part of the Lance Armstrong Foundation Adult Survivorship Program at Dana-Farber/Brigham and Women’s Cancer Center. The Program features an adult survivorship clinic that evaluates patients for long-term and late effects of cancer treatment and, together with their primary care provider, discusses their survivorship needs. Specialists in the Adult Survivorship Program develop a complete, individual assessment of each patient’s survivorship needs and provide a treatment summary and follow-up care plan, as well as recommendations for referrals to any other testing or specialists for follow-up care.

Case Study:

Managing Therapy-induced Renal Failure
A patient with renal cell carcinoma was treated with gemcitabine and sunitinib, but developed hypertension, proteinuria, and renal failure (Figure 1). A renal biopsy (Figure 2) showed thrombotic microangiopathy, a known toxicity of both gemcitabine and sunitinib. Specialists in the Onco-Nephrology Program and the Genitourinary Cancer Treatment Center collaborated in the patient’s care, starting renal protective therapies and holding therapy. The patient made a full recovery. She later resumed cancer therapy with a different medication in the same class with good tumor response and no renal toxicity.

MRI scan

MRI scan demonstrating an enhancing, partially exophytic tumor on the
posterior of the right kidney.

Robotic Partial Nephrectomy
Enabling patients to maintain full renal function, partial nephrectomy is becoming more widely available for the treatment of kidney masses, including relatively large tumors – depending on their location.

While up to 60 percent of kidney tumors discovered today are small incidental renal masses that are often suitable for partial nephrectomy, many patients unnecessarily undergo radical nephrectomy. Radical nephrectomy places patients at increased risk for chronic kidney disease, cardiovascular disease, stroke, and repeat hospitalizations.

Urologic surgeons Adam S. Kibel, MD, Surgical Director, Center for Genitourinary Oncology, Dana-Farber/Brigham and Women’s Cancer Center, and Chief, Division of Urology, Brigham and Women’s Hospital, and Steven L. Chang, MD, are among few in New England to offer robotic partial nephrectomy. Robotic partial nephrectomy provides patients with a faster rate of recovery, reduced pain, and less risk of complications compared with open techniques. Typically, kidney tumors that are 4cm or less in size, as well as larger tumors located on the periphery of the kidney, are eligible for partial nephrectomy.

Partially exophytic tumor

Partially exophytic tumor is identified on the posterior of the kidney. The line of excision is marked with cautery (above). The robotic technique is used to excise the tumor while preserving the normal portions of the kidney (below).

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