Personalized therapy best for kidney cancer

NEW YORK (Reuters Health) - A study of nearly 1,500 patients treated for kidney cancer at the University of California-Los Angeles in the last 15 years indicates that patients may benefit from an individualized treatment approach.

The one-size-fits-all treatment approach traditionally used for kidney cancer should be changed based on the results of this study, the researchers say.

“We have shown that not all kidney cancer patients are the same, not all localized (organ-confined) kidney cancers are the same and not all metastatic kidney cancers are the same,” lead researcher Dr. Arie S. Belldegrun from the UCLA David Geffen School of Medicine noted in a written statement. Metastatic disease refers to cancer that has spread beyond the kidney.

In analyzing the outcomes of a large group of kidney cancer patients, the investigators found that patients with localized cancer may have low, intermediate or high risk cancers based on the odds for recurrence.

In the past, all of these patients with cancers that have not spread “may have been treated the same way,” Belldegrun said. “They need to be treated individually according to their risk levels. We outline the foundation for personalized kidney cancer therapy.”

The data also indicate that surgery to remove the kidney (nephrectomy) alone “is not sufficient to cure all patients” with localized cancer and that effective add-on therapies are needed for those with high-risk disease.

Similar to patients with localized kidney cancer, patients with kidney cancer that has spread could also be grouped into low, intermediate and high risk groups.

This research “identifies, very precisely, which patients should get which therapies,” Belldegrun said.

For example, a low-risk patient with localized disease could expect a very good outcome with surgery alone. On the other hand, the researcher explained, a low-risk patient with metastatic cancer should get very aggressive treatment, because the odds are good that the therapy will help. Those with high-risk, metastatic disease, however, are unlikely to benefit from treatment and may want to forego surgery and toxic therapies.

The researchers suggest that their findings be used as a benchmark with which to compare three recently FDA-approved targeted therapies for kidney cancer -- sorafenib, sunitinib, and temsirolimus.

SOURCE: Cancer, November 1, 2008.