Dr. Pili answers questions about kidney cancer

Monday, April 9, 2018

Roberto Pili, M.D., a nationally recognized expert in prostate, renal and bladder cancers, is the Robert Wallace Miller Professor of Oncology at Indiana University School of Medicine and a researcher at the IU Simon Cancer Center. He recently answered some questions about kidney cancer.

Q: What are the types of kidney cancer and which is most common?

Dr. Pili: Nearly 70 percent to 80 percent of all cases of kidney cancer, also known as renal cell carcinoma, are from the clear cell type. The second most common form is papillary renal cell carcinoma type 1 and type 2. Other subtypes of kidney cancer include chromophobe, collecting duct and unclassified renal cell carcinoma. Transitional cell carcinoma is a rare but quite aggressive kidney cancer, a subtype that our lab is actively investigating to identify more effective therapies. Kidney cancer is more prevalent in men than in women. Renal cell carcinoma is the seventh most common cancer in men and the 10th most common in women. The average age for diagnosis is approximately 60 years.  

Q: What are some of the symptoms of kidney cancer and how is it diagnosed?

Dr. Pili: The majority of kidney tumors are usually diagnosed by accident when the patient has a CT scan or MRI for another reason and the kidney tumor is discovered. Unfortunately, one-third of the patients present with already advanced kidney cancer because people often do not develop symptoms – such as blood in urine, abdominal or back pain, fatigue, unexplained weight loss and unexplained fever – until the disease has spread outside the kidney.

Q: Do all patients with kidney cancer undergo surgery to remove a kidney or part of a kidney?

Dr. Pili: Decisions about surgery for patients with kidney cancer are made in consultation with the patient’s urologist and oncologist. Before any treatment plan is approved, the cancer should be first staged through a variety of diagnostic tests. In the early stages of the disease – Stage I and Stage II – the tumor remains confined to the kidney. In Stage III and Stage IV, the tumor has escaped the confines of the organ and may have spread to lymph nodes or other organs. Even in the presence of metastatic disease, if the tumor is primarily in the kidney or the patient has bleeding or pain from the primary tumor, it is usually removed after consultation with the urology team. Kidney cancer is different from other forms of cancer such as tumors of the lung, breast, colon, etc., where we don’t recommend removal of the primary tumor in the presence of disease outside the primary organ.

Q: Do all patients with kidney cancer receive drug therapy?

Dr. Pili: In most cases of metastatic disease, we recommend surgery followed by treatment with drugs. The two major FDA-approved drug therapies for kidney cancer are immunotherapies, which boost the immune system to kill cancer cells, and targeted therapies. Targeted therapies differ from standard chemotherapy in that they act on specific molecules to block the growth of cancer cells, whereas standard chemotherapy attacks and kills cells. Kidney cancer has always been an orphan disease because the cells are naturally resistant to toxins so the chemotherapy drugs don’t work the same way as they do in other diseases. More than 10 years ago, the first of a new class of drugs known as protein kinase inhibitors was approved for use in kidney cancer. Prior to that, drug therapy was limited to interferon alpha and interleukin 2. Now there is a long list of drugs that can be used.

Q: Recently, the Food and Drug Administration approved a new drug for use as a first-line treatment for advanced renal cell carcinoma. Is this a new approach to treatment of kidney cancer or is it an additional tool in the physician’s therapy choices?

Dr. Pili: The new drug approved is a targeted therapy that suppresses proteins that promote the growth of blood vessels and tumor cells. There are several versions of this type of drug approved for use for kidney cancer and each one works in a little different way to give oncologists additional options when patients stop responding well to specific drugs. More excitingly, the use of immune checkpoint inhibitors is revolutionizing the treatment of several solid tumor types, including renal cell carcinoma, and we expect that new combinations of drugs boosting the immune systems will be approved shortly. All of the FDA-approved treatments for kidney cancer are available at the IU Simon Cancer Center, as well as many study drugs available in clinical trials.   

Q: Are there any promising clinical trials for kidney cancer treatments that you would recommend to your patients?

Dr. Pili: We have a very active research program in kidney cancer at the IU Simon Cancer Center and several clinical trials are in progress or about to open. Many of these studies are comparing the effectiveness of different drug combinations, primarily with immunotherapies. A complete list of clinical trials at the IU Simon Cancer Center can be found at cancer.iu.edu/trials. Additional information on clinical trials for kidney cancer can be found on the National Cancer Institute website.

Q: What research are you doing in your research lab regarding kidney cancer?

Dr. Pili: Our group is looking for protein markers on cancer cells that can act as targets for new drugs. Another approach to our research is developing combination therapies so we can overcome the mechanisms that cause the patient to stop responding to either targeted therapies or immunotherapies and therefore make the treatments more effective. We are hopeful that our laboratory and clinical research will have an impact on our kidney cancer patients.

To Learn More

To learn more about kidney (renal cell) cancer, visit the National Cancer Institute.