Kidney Cancer Awareness

Transcript

• 00:00Funding for Yale Cancer Answers is
• 00:02provided by Smilow Cancer Hospital.
• 00:06Welcome to Yale Cancer Answers with
• 00:09your host doctor Anees Chagpar.
• 00:11Yale Cancer Answers features the
• 00:13latest information on cancer care by
• 00:15welcoming oncologists and specialists
• 00:16who are on the forefront of the
• 00:19battle to fight cancer. This week,
• 00:21it's a conversation about kidney
• 00:22cancer with Doctor David Braun.
• 00:24Doctor Braun is an assistant professor
• 00:26of medicine and medical oncology
• 00:28at the Yale School of Medicine,
• 00:29where Doctor Chagpar is a
• 00:32professor of surgical oncology.
• 00:34David, maybe we can start off
• 00:36by you telling us a little bit
• 00:38about yourself and what you do.
• 00:39Yeah, absolutely.
• 00:40So I'm actually new to the Connecticut area.
• 00:44I'm a physician, scientist and really
• 00:46my focus has been on kidney cancer.
• 00:48That's both in the clinic where
• 00:50I see patients with variety of
• 00:51different types of kidney cancer,
• 00:53including advanced kidney cancers.
• 00:54And then I spent a large portion of
• 00:56my time in the laboratory as well,
• 00:58really trying to understand this disease
• 01:00and think of are there new approaches,
• 01:02particularly using the immune system itself.
• 01:04Immuno therapies.
• 01:05To try to attack and tackle kidney cancer.
• 01:09Wow, there's a. There's a lot to
• 01:10unpack in which you just said so maybe
• 01:12we'll start off with kind of a bigger
• 01:14understanding of kidney cancer in general,
• 01:16especially because kidney cancer Awareness
• 01:18Month is coming up and a lot of us might
• 01:21not be very familiar with kidney cancer.
• 01:24We hear a lot about breast cancer
• 01:26and colon cancer and lung cancer,
• 01:28but we don't really hear a
• 01:30whole lot about kidney cancer.
• 01:31So tell us a little bit more about it.
• 01:33How common is it?
• 01:34Who gets affected by it?
• 01:36Then why should we care?
• 01:37Yeah, absolutely.
• 01:38And so I think you're absolutely right.
• 01:41I think you know a lot of the time
• 01:42when people think about cancers.
• 01:44They think about the really common types.
• 01:45Unfortunately, breast cancer and
• 01:47colon cancer and lung cancer.
• 01:48But kidney cancer is still effects
• 01:50a very large number of people.
• 01:52So just in the US,
• 01:53each year there's about 75,000 people that
• 01:56will be diagnosed with kidney cancer.
• 01:59And unfortunately,
• 01:59even with our advancements in
• 02:01medicines and new types of therapies,
• 02:03still nearly 15,000 people a
• 02:05year will die from kidney cancer.
• 02:07And so it really is.
• 02:08An important and impactful illness
• 02:10that that really needs to be
• 02:12addressed in terms of who it can
• 02:14affect the short answer is anyone.
• 02:16It does have a little bit of
• 02:17a preference for certain ages
• 02:19and these sorts of things,
• 02:20but really can affect people
• 02:23across the spectrum.
• 02:24If we say what is the sort of most
• 02:26common person who might get it?
• 02:27It does have a a slight increase
• 02:30in men versus women,
• 02:32so about twice as many men will
• 02:35get kidney cancer as as women and
• 02:37then it does tend to affect people.
• 02:39Who are a little bit on the older side,
• 02:41so the median age would be in
• 02:44the 60s and it can be anywhere,
• 02:46though from you know people that
• 02:48are in their 80s and 90s and beyond
• 02:50and unfortunately can happen in
• 02:52the other direction as well,
• 02:53where I've had patients in their
• 02:5530s or 40s who have been diagnosed,
• 02:57and so it really can affect a
• 02:59really wide range of ages,
• 03:01but typically in that early 60s range
• 03:04cool and so you know,
• 03:07just while you're talking about
• 03:09kidney cancers and. And age groups.
• 03:11Some people may have heard about
• 03:13kidney cancers occurring in
• 03:16pediatric patients in children.
• 03:18Things like, you know,
• 03:21Wilms tumors and nephroblastoma's
• 03:24talk about how that is different from
• 03:27what I think you're talking about in
• 03:29terms of kidney cancers in adults,
• 03:32absolutely so. By and large,
• 03:34this very rare exception to this,
• 03:36but for the vast majority of cases,
• 03:39the kidney cancers that occur in adults.
• 03:41Are completely different biologically.
• 03:43They they start in a different way.
• 03:46They function in a different
• 03:47way and they're treated in a
• 03:49different way than kidney cancers.
• 03:50Kidney tumors that might occur in kids.
• 03:54Again, this very slight exception to that,
• 03:56but I think as a general rule,
• 03:58the the Group of kidney cancers or
• 04:01kidney tumors that might occur in
• 04:03kids are really almost different.
• 04:04Disease bucket a completely different
• 04:06entity than the ones that occur in adults.
• 04:10They just wanted to gain of get that
• 04:13out at the top simply so that our
• 04:16audience really knows that we're we're
• 04:18talking about what in medical lingo
• 04:21is is known as a renal cell carcinoma.
• 04:25For the most part, is that right?
• 04:27Absolutely, that's exactly right.
• 04:29The the technical term
• 04:30is renal cell carcinoma,
• 04:32and that's a group of kidney cancers
• 04:34that happen for adult patients.
• 04:36And it actually encompasses a whole
• 04:38range of diseases, including.
• 04:40Significantly more common ones,
• 04:43but also rare types of kidney cancer as well,
• 04:45but that is the a good general term to
• 04:47describe the this bucket of illnesses,
• 04:50and so you know when you say
• 04:52that everybody can get this.
• 04:54I'm sure that people are wondering,
• 04:56you know, are there things
• 04:57that can increase your risk or
• 04:59decrease your risk so you know?
• 05:01Oftentimes we're asked?
• 05:02While does smoking increase
• 05:03my risk of kidney cancer?
• 05:05Does alcohol consumption increase my risk?
• 05:08What about occupational hazards?
• 05:10Environmental risks?
• 05:11Tell us more about that.
• 05:14Yeah, it's a good question and I
• 05:16think the short answer is we don't
• 05:18have the same association between
• 05:20kidney cancer and certain risk factors
• 05:22like lung cancer has with smoking.
• 05:24So you know lung cancer.
• 05:26There's a really huge increase
• 05:28with with smoking.
• 05:30For kidney cancer,
• 05:31there are things that change the
• 05:33likelihood by relatively small amounts,
• 05:35so people who have inflammatory conditions
• 05:38of the kidney and these sorts of things
• 05:40do increase it by a small amount there.
• 05:43Similarly,
• 05:44these rare cases of exposures,
• 05:47military exposures that have sort
• 05:48of been associated with these
• 05:50clusters of kidney cancers,
• 05:51but the transfer is those tend to be the
• 05:55exception more so than the rule in general.
• 05:57For most patients,
• 05:59kidney cancers tend to be sporadic.
• 06:01Again, there's always exception to this.
• 06:02There's sometimes genetics,
• 06:04might play a role.
• 06:05Kidney cancers can run in the family.
• 06:08This particular types of
• 06:09hereditary cancer syndromes.
• 06:11There's again these histories of particular
• 06:13exposures or things that might make a
• 06:16difference truthfully around the margins.
• 06:17But by and large,
• 06:19these sporadic kidney cancers
• 06:21that occur are really.
• 06:24There's not a huge association between that
• 06:28and particular modifiable lifestyle factors.
• 06:31And so I think the general advice
• 06:32I would have is you know the things
• 06:34that are good for your heart and
• 06:35your health overall are are probably
• 06:37good for your cancer as well,
• 06:38and so I encourage patients you
• 06:40know to have a well balanced diet.
• 06:42I encourage patients to, you know,
• 06:45engage in regular exercise.
• 06:46These sorts of things because that's
• 06:48good for someone's overall health.
• 06:50But in terms of particular risk
• 06:52factors for kidney cancers,
• 06:53it probably makes less of an impact.
• 06:56So so really, you know,
• 06:58getting kidney cancer is really
• 06:59a matter of just bum bad luck.
• 07:01Somebody's gotta get it.
• 07:02And so you know,
• 07:03people who get it kind of get it is
• 07:05basically what you're telling us.
• 07:07They're the the the risk
• 07:08factors that you can really
• 07:10modify are few and far between.
• 07:12I I think that's absolutely right,
• 07:14and I think honestly, that's something
• 07:15I highlight to my patients as well,
• 07:17because sometimes people come in and
• 07:18there's almost a sense of guilt.
• 07:20What could I have done differently
• 07:22to have not gotten this this illness?
• 07:25The short answer is,
• 07:26this is just terrible luck that
• 07:28we don't fully understand yet,
• 07:29but that it's not something where there is a.
• 07:32A clear modifiable thing that someone
• 07:34could have done to prevent it,
• 07:36and so David, given the fact that you
• 07:39know kidney cancers aren't something
• 07:40that we often think about top of
• 07:43mind in terms of the the more common
• 07:45cancers and the fact that it can
• 07:47affect almost anybody who has a kidney,
• 07:49which is pretty much everybody.
• 07:51Tell us about how you would pick this up.
• 07:54I mean there there doesn't seem to
• 07:56be any real screening tests for
• 07:59kidney cancer like there is for
• 08:01breast cancer or colorectal cancer.
• 08:03So what signs or symptoms should
• 08:06people be looking for and seeking
• 08:08attention for that might lead
• 08:10to a diagnosis of kidney cancer.
• 08:14It's a, it's a wonderful question and
• 08:16I think the first thing I'd address is
• 08:18maybe the screening aspect that you know.
• 08:20I think that's an area of
• 08:22active investigation and we
• 08:23hopefully will do better.
• 08:25We need to do better,
• 08:26but we're we're really not there yet
• 08:28and there's many research groups.
• 08:30Wonderful research groups that
• 08:31have are working on this idea.
• 08:33Can we have a blood based test or
• 08:35something where we be able to pick up
• 08:37kidney cancer at an earlier stage,
• 08:39but we have to make sure that we
• 08:41rigorously test those and and see how
• 08:44those performing those coming years.
• 08:46'cause that would be a wonderful
• 08:47tool to have,
• 08:48but you're absolutely right right now.
• 08:50What is the way that we would
• 08:51pick up kidney cancer?
• 08:53It's something I would call clinically.
• 08:54Who's a patient comes with particular
• 08:57signs or symptoms or incidentally,
• 09:00meaning people are having an
• 09:02evaluation for another purpose,
• 09:04and this happens to just be found.
• 09:06So I would say historically there's
• 09:08a group of symptoms that a patient
• 09:10might experience that have been
• 09:12associated with kidney cancer.
• 09:14There's a sort of classic symptoms.
• 09:16Of blood in the urine of having flank pain.
• 09:20Pain towards the side or the
• 09:22back where the kidney tumor is.
• 09:24These sorts of symptoms actually occurred.
• 09:27A really a minority of patients
• 09:29that you know the the group of
• 09:31patients really experiencing.
• 09:32All of these constellation of symptoms
• 09:34is probably less than one out of 10,
• 09:36and so I would say a few things.
• 09:38One is a large proportion are
• 09:41actually picked up incidentally,
• 09:42so people have back pain or some
• 09:44other issues. Stomach pains.
• 09:46Totally unrelated to the kidney cancer
• 09:48and they have a CAT scan or an MRI
• 09:50and the kidney cancer is just picked up.
• 09:52Incidentally,
• 09:53that's sort of one group of patients.
• 09:55The second group of patients are
• 09:57ones I would say have something
• 09:59I would term local symptoms,
• 10:00meaning symptoms that they experience
• 10:02because of the kidney tumor itself.
• 10:05So there are patients that experience,
• 10:06for instance,
• 10:07blood in the urine that they
• 10:09can actually see.
• 10:10If anyone sees that,
• 10:11that's something that's a definitely
• 10:12a good idea to talk to your doctor
• 10:14about and to pursue an evaluation for
• 10:15if there's ever blood in the urine.
• 10:17Sometimes that's really blood
• 10:19that you can see.
• 10:20Sometimes people have a urine
• 10:21test for another reason,
• 10:22and there's microscopic blood that too
• 10:25should be evaluated more thoroughly.
• 10:27It's can sometimes cause pain
• 10:29in the area or discomfort these
• 10:31kidney tumors you know,
• 10:33for some patients they're
• 10:35they're totally asymptomatic,
• 10:36but for some they can grow to
• 10:38size where they actually cause
• 10:39bloating or discomfort,
• 10:41and so any of those things that happen
• 10:43because they're just where the kidney
• 10:45tumor itself itself is either pain
• 10:47or bloating or even blood in the urine.
• 10:49That's a second group of patients.
• 10:51I would call the local
• 10:53symptoms and the final group,
• 10:55which is less common but can
• 10:56occur, are what I would call
• 10:58systemic symptoms and what I mean
• 11:00by that is it's not related to the
• 11:03position of the kidney tumor itself,
• 11:05but the kidney cancer can sometimes
• 11:07produce factors and things in the body
• 11:10that just make people generally feel on
• 11:12where well they might experience fevers
• 11:15or weight loss sweats during the night.
• 11:17Things that are not sort
• 11:18of accounted for for.
• 11:20Other reasons, again less common,
• 11:22but some patients really can't
• 11:24present with those systemic symptoms.
• 11:26And so that's a that's a a lot of things,
• 11:29and so I would say my my sort of
• 11:32general approach to these things.
• 11:34Are there certain things like
• 11:35blood in the urine?
• 11:36I really think of getting into
• 11:38valuation with your doctor.
• 11:39I think that's that's always a good
• 11:41idea for things that are, you know,
• 11:43more common aches and pains.
• 11:45Things that we were all gonna
• 11:47experience in our lives,
• 11:48the sort of rule I have is everyones
• 11:50entitled to those aches and pains.
• 11:52But if there's something
• 11:53that's unusually severe,
• 11:55you know it's not not something that.
• 11:56Feels like you've had in the past.
• 11:58It really is more severe in terms of its
• 12:01intensity or it's lasting longer than that.
• 12:04You think it should?
• 12:04You know you've had back pain in
• 12:06the past and it comes and goes.
• 12:07This is kind of there and it's
• 12:09really lingering for quite a while.
• 12:10Those are are, you know,
• 12:12maybe a little bit of a red flag.
• 12:13That's time to go.
• 12:14See your doctor and get an evaluation.
• 12:17Especially because some of
• 12:19these things, like you know,
• 12:20having a little bit of blood in the
• 12:21urine and a little bit of flank pain.
• 12:23Most people would think of a kidney
• 12:25stone rather than a a kidney tumor,
• 12:28and me say, well,
• 12:28you know I've had kidney stones in the past,
• 12:30and so this is just yet another bout.
• 12:33Speaking of which, though,
• 12:35does having a history of kidney
• 12:37stones increase your risk of
• 12:38developing kidney cancer?
• 12:41It's a good question.
• 12:42I would say anything that can
• 12:44cause inflammation in the kidney.
• 12:45In theory, can create an
• 12:48environment that's more susceptible
• 12:49to developing kidney cancer,
• 12:51and so you know on a routine basis,
• 12:53someone who gets the stone here there,
• 12:56you know probably doesn't have that
• 12:57much of a different risk unfortunately.
• 12:59Some patients who really get a lot
• 13:02of effects of that kidney stone.
• 13:04Those blockages and infections,
• 13:07and recurrent inflammation.
• 13:08Those probably do have a slightly
• 13:10higher risk just because of that.
• 13:12That inflammation within the
• 13:13Kitty it sort of creates an
• 13:14environment that's more pervasive
• 13:16to developing a kidney cancer,
• 13:18and so you know, when you think about it,
• 13:21you know the the kind of you
• 13:23know a little bit of flank pain,
• 13:24maybe a little bit of blood in
• 13:26the urine in a minority of cases.
• 13:29Maybe you know a little bit of aches
• 13:32and pains when things that you know
• 13:35without something that is rip roaring.
• 13:37You know, alarm bell ringing.
• 13:41Many of these patients are
• 13:42either going to be.
• 13:43Picked up incidentally on a CAT scan
• 13:46that they're having for another reason.
• 13:48Or it may be delayed and so that
• 13:51brings us to the question of
• 13:54what is the stage distribution of
• 13:56kidney cancers when they present.
• 13:58So that is to say,
• 14:00are most of these cancers picked up
• 14:02late simply because there is no alarm
• 14:05bell ringing symptoms that cause
• 14:07people to seek medical advice sooner?
• 14:11Good question. I think something
• 14:13that's evolving in and really changing
• 14:15overtime because things like CAT scans
• 14:17are more common now either for other
• 14:20reasons that are unrelated to the
• 14:21kidney cancer or because people do have
• 14:23that twinge of pain or have blood in
• 14:26the urine and they see their doctor.
• 14:27And appropriately they say,
• 14:29let's let's get a CAT scan to evaluate.
• 14:31I think things are being picked
• 14:32up earlier and earlier and so
• 14:34the majority of kidney cancers,
• 14:35which is good news are picked up at
• 14:37a localized stage as a stage where
• 14:40they're confined the kidney and.
• 14:41Where surgery can be performed or
• 14:43other there's other methods as well,
• 14:45but basically that single tumor
• 14:47can be can be addressed,
• 14:49and in most cases eliminated,
• 14:51and that's that's wonderful news.
• 14:53That being said,
• 14:54you know there are select group
• 14:56of patients that we don't have
• 14:58great screening for and that don't
• 15:00have any warning signs early on.
• 15:02And by the time that you know
• 15:03the really symptoms develop,
• 15:04it is at a more advanced stage.
• 15:06And while that's the minority
• 15:07of patients at this point,
• 15:09it is still a sizable fraction.
• 15:11And so something that I think
• 15:13motivates our need to really
• 15:15do better in terms of coming up
• 15:17with better screening tests.
• 15:18And so we're going to pick up the
• 15:20conversation, learning more about
• 15:21the research that's evolving in
• 15:23terms of screening and treatment,
• 15:25right after we take a short break,
• 15:26quit for a medical minute.
• 15:28Please stay tuned to learn more
• 15:29about kidney cancer with my
• 15:31guest Doctor, David Braun.
• 15:33Funding for Yale Cancer Answers
• 15:35comes from Smilow Cancer Hospital,
• 15:37where the breast Cancer Prevention Clinic
• 15:39provides comprehensive risk assessment,
• 15:41education and screening for women
• 15:43at increased risk of breast cancer.
• 15:45To learn more, visit
• 15:48yalecancercenter.org/genetics.
• 15:51Over 230,000 Americans will be
• 15:53diagnosed with lung cancer this
• 15:55year and in Connecticut alone
• 15:57there will be over 2700 new cases.
• 16:00More than 85% of lung cancer
• 16:03diagnosis are related to smoking and
• 16:05quitting even after decades of use
• 16:08can significantly reduce your risk
• 16:10of developing lung cancer each day.
• 16:12Patients with lung cancer are surviving
• 16:14thanks to increased access to advanced
• 16:17therapies and specialized care,
• 16:18new treatment options and surgical
• 16:20techniques are giving lung cancer survivors
• 16:22more hope than they have ever had before.
• 16:25Clinical trials are currently
• 16:27underway at federally designated
• 16:29Comprehensive cancer centers,
• 16:30such as the battle two trial at
• 16:32Yale Cancer Center and Smilow
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• 16:36or combination of drugs based on
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• 16:40control non small cell lung cancer.
• 16:43More information is available at
• 16:46yalecancercenter.org you're listening
• 16:47to Connecticut Public Radio.
• 16:50Welcome back to Yale Cancer Answers.
• 16:52This is doctor Anees Chagpar and I'm joined
• 16:54tonight by my guest Doctor David Braun.
• 16:56We're learning about the care of
• 16:59patients with kidney cancer in
• 17:01advance of kidney cancer awareness
• 17:03Month and right before the break,
• 17:05you know, David, you were telling us
• 17:07a bit about kidney cancers and the
• 17:10fact that almost anybody had is at
• 17:13risk of developing kidney cancers.
• 17:15But you did mention a few things
• 17:18that I think were really.
• 17:20Interesting in terms of where the
• 17:22science is going in terms of picking
• 17:25up cancers earlier and treating
• 17:27them perhaps more effectively.
• 17:29So tell us a little bit more about some
• 17:32of the research that's ongoing that will
• 17:34help us to find kidney cancers early,
• 17:37absolutely, and so there's really,
• 17:39I think, dramatic advances that are
• 17:41being made both in terms of research
• 17:43into screening and then ultimately,
• 17:45which is a huge focus of mine treatment.
• 17:48Unfortunately, for patients who
• 17:49develop more advanced disease where.
• 17:52A surgery is not possible or not effective.
• 17:54What are the treatments
• 17:56available in terms of screening?
• 17:58You know historically,
• 17:59a lot of the screening that's been
• 18:00done for many types of cancer
• 18:02has been imaging based this some
• 18:04sort of picture that's taken,
• 18:05whether that's a form of an X ray,
• 18:07like a mammogram,
• 18:08or whether that's a CT scan at low doses
• 18:11like they have available for lung cancer,
• 18:14and so that's one bucket that people have
• 18:16looked at and are continuing to look at.
• 18:18Even simple tools like ultrasound.
• 18:20Whether that might be helpful.
• 18:22In terms of really picking up kidney cancer,
• 18:24particularly in certain populations.
• 18:26That being said,
• 18:28you know I'm not as optimistic
• 18:30that we're gonna really have a
• 18:32pure imaging based solution,
• 18:34and that's where some of the research
• 18:36into what I would call blood tests
• 18:38as a general bucket is really,
• 18:40really exciting.
• 18:40We know that cancer is even
• 18:42at an early stage,
• 18:44sometimes shed some of their blueprints that
• 18:46shed some of their DNA into the bloodstream.
• 18:49Very,
• 18:49very small amount and kidney
• 18:51cancer in particular.
• 18:52Actually sheds less of this DNA
• 18:54than a lot of other tumor types,
• 18:56but it still does shed some some DNA,
• 18:59and so the question is,
• 19:00can we actually use new and advanced
• 19:03methods of picking up that needle
• 19:05in a haystack that little bit of
• 19:07shed DNA from a tumor and being
• 19:09able to identify it in a patient
• 19:11with an early stage kidney cancer?
• 19:13But they're still at the research phase,
• 19:14so not the phase where they've been
• 19:16proven to really be effective in a
• 19:18large group of patients with picking it up.
• 19:20But I still think there's room
• 19:22there for cautious optimism.
• 19:24The second bucket just mentioned briefly
• 19:26is we know that cancer in general
• 19:28and kidney cancer is no exception,
• 19:30can alter patients metabolism in
• 19:32subtle ways the the make up of,
• 19:34you know, simple things,
• 19:35amino acids and fats in our in our
• 19:38bloodstream and so another area
• 19:40of investigation that a number of
• 19:42groups including our own has been
• 19:44involved in is saying can we actually
• 19:46pick up on those subtle changes
• 19:48and their metabolites that might be
• 19:49present in a patient's blood and
• 19:51see if that can help us actually
• 19:53distinguish patients with even an
• 19:54early stage cancer from patients
• 19:56who don't have cancer and so.
• 19:57Again,
• 19:59exciting sort of areas of investigation,
• 20:02but nothing where we have a test today
• 20:03or tomorrow that I can say this is
• 20:05a good test for screening for kidney cancer.
• 20:07You know, the kidney is one of these organs.
• 20:10That is one would think would be
• 20:12particularly ripe for for screening
• 20:15in the sense that it generates urine.
• 20:18So are there urine based tests
• 20:21that are being looked at for
• 20:23screening and early detection?
• 20:25Or is it all blood based?
• 20:28No, it's it's a wonderful point and
• 20:31so essentially everything I said that
• 20:33was applied to blood based tests.
• 20:35People are looking at within the
• 20:36urine as well to see, you know,
• 20:38is there DNA that shed that
• 20:40can be picked up in the urine?
• 20:42It turns out at least our early experiences.
• 20:44It seems like it's a little bit more tricky.
• 20:46For whatever reason,
• 20:47it tends to be shed a little bit
• 20:50less in the urine than the blood,
• 20:51even though it's not very prevalent
• 20:53in the blood either.
• 20:55That being said,
• 20:55I think that's an area for
• 20:57continued investigation.
• 20:58The one urine test,
• 20:59which is an old one but still a
• 21:01tried and true is if there is blood
• 21:02that's picked up on a urine test,
• 21:04even microscopic blood.
• 21:05That's something that's certainly
• 21:07worthwhile to evaluate more fully,
• 21:10because that can be an early sign
• 21:11of of something going on within
• 21:13the kidney or or other areas within
• 21:15that that track that urinary tract.
• 21:19You know that I I always like to
• 21:21think about urine tests just in
• 21:22case there are people out there who
• 21:25don't particularly love needles.
• 21:26Even though the the tests that we get
• 21:28for blood tests are a small needle.
• 21:30But some of us are still little gun shy.
• 21:35So so you know we we kind of left off
• 21:38the conversation before the break at.
• 21:40You know, detecting kidney cancers
• 21:43tell us what the state of the art is at
• 21:47the moment in terms of how effective
• 21:49treatments are for kidney cancers.
• 21:52I mean, it's great that most of them
• 21:54are picked up at a local stage,
• 21:56so how are they treated?
• 21:57Is this just a surgery or are do
• 22:00people need radiation and systemic
• 22:03therapy like chemotherapy
• 22:05as well? It's it's a great
• 22:08question and the the short answer
• 22:10really depends on where it is.
• 22:13And so anytime there's a patient that I
• 22:15meet that's diagnosed with a new cancer.
• 22:16I always ask 3 fundamental questions.
• 22:19What is it? Where is it and what
• 22:22are we going to do about it?
• 22:23And that's where the treatment
• 22:24comes in and so the what is it is
• 22:26what type of kidney cancer we have,
• 22:28much more common types like clear cell
• 22:31kidney cancer that account for about 80%,
• 22:33but there's also less common
• 22:35types these variantes allergies.
• 22:37That have unique biologies that we need
• 22:39to understand that sometimes might
• 22:41affect treatment in certain ways.
• 22:43The next big question is where is
• 22:44it and that that really ties in
• 22:46with the stage and the prognosis,
• 22:48and that's ultimately what will help
• 22:50to determine the treatment and so
• 22:52patients who have an early stage
• 22:54kidney cancer stage one or stage two.
• 22:57Those are ones where treatments that
• 23:00that tumor itself, usually surgery,
• 23:02though there's emerging roles for
• 23:04other techniques like ablation
• 23:05or even radiation as well,
• 23:07but for the majority of patients surgery.
• 23:09To remove that kidney tumors,
• 23:10highly,
• 23:11highly effective and patients with early
• 23:14stage kidney cancer who have surgery.
• 23:16The far majority of those patients
• 23:18are cured with surgery alone.
• 23:20The second bucket are patients that
• 23:22have what I would term locally
• 23:25advanced or locally aggressive
• 23:27disease that's kidney cancer.
• 23:28That's still within the kidney itself.
• 23:30It hasn't spread far,
• 23:31but maybe it started to go into a little
• 23:34bit of a blood vessel or surrounding area,
• 23:36or it has features under the
• 23:38microscope that look really aggressive.
• 23:40Still,
• 23:40the mainstay of treatment for
• 23:42that is surgery,
• 23:43and that's that's curative for
• 23:45a large number of patients.
• 23:47But unfortunately there are still a
• 23:49number of patients who after surgery.
• 23:51Will have the disease come back and
• 23:54so there haven't been great tools in
• 23:56terms of being able to help prevent
• 23:58it from coming back like radiation
• 24:01after surgery or chemotherapy just now.
• 24:03In the last really year,
• 24:06we're beginning to have some evidence
• 24:08that actually immunotherapy might help
• 24:09to decrease the risk of it coming back.
• 24:11It still needs a little bit
• 24:13of longer follow up,
• 24:13but that's that's actually has led
• 24:15to the FDA approval of one of these
• 24:18immunotherapy drugs for exactly this purpose.
• 24:20Those patients with kind of a higher risk.
• 24:22Local kidney cancer that's removed
• 24:24by surgery.
• 24:25Can we get another medicine and
• 24:27immunotherapy to help decrease the
• 24:29chance of it coming back? And the last?
• 24:31The last group of patients?
• 24:32And this is largely the group of
• 24:33patients that I see are unfortunately
• 24:35those with advanced or metastatic disease.
• 24:37Kidney cancer that's either spread
• 24:39to different areas at the beginning
• 24:41or start off in the kidney and
• 24:43recurred or came back later at
• 24:45different parts of the body.
• 24:47And so that point in general,
• 24:49with with some exceptions.
• 24:50But in general those are patients
• 24:52that are not cured by surgery alone.
• 24:54And that's where we really
• 24:55think of medicines.
• 24:56Systemic therapy as the the
• 24:58really the mainstay of treatment.
• 25:00Now, what are those medicines
• 25:02kidney cancers really by and large,
• 25:04not been historically responsive to
• 25:06the conventional chemotherapies we
• 25:08think of the stuff that you know,
• 25:10come through the Ivy that we think.
• 25:12Make people feel really sick.
• 25:14Those are things that you know for.
• 25:15For the majority of kidney
• 25:17cancers are against small,
• 25:18rare exceptions here,
• 25:19but for the majority
• 25:20they're just not effective,
• 25:22and so there's been two big waves
• 25:24of treatment for kidney cancer.
• 25:26The first wave,
• 25:27which started around 15 years
• 25:28ago were group of medicines,
• 25:30mostly pills.
• 25:31But there's other Ivy form as well that
• 25:33helped to block new blood vessel formation.
• 25:36So called anti angiogenic.
• 25:37So those were really effective for a while.
• 25:39They they truthfully didn't
• 25:40really cure patients,
• 25:41they the farm majority didn't
• 25:42get rid of it but they provided
• 25:44a treatment that could at least
• 25:45keep the kidney cancer at Bay for
• 25:47some amount of time and went from
• 25:49having very little in the way
• 25:51of treatment to actually being
• 25:52able to keep the disease under
• 25:54control for some amount of time.
• 25:55So that was a really important
• 25:57and exciting advance.
• 25:58What I think has been transformative, really.
• 26:00Over the last five or so years has
• 26:02been the the introduction of this
• 26:05next generation of immune therapy.
• 26:07There's actually an older form of immune
• 26:08therapy that was used 20 or 30 years ago,
• 26:10which you know,
• 26:11actually had some favorable responses
• 26:13for a very small group of patients,
• 26:16maybe 5 or 7%.
• 26:17But with this new wave of immune therapy,
• 26:21these so-called immune checkpoint inhibitors,
• 26:24it's I think,
• 26:24really marked an inflection point
• 26:26for kidney cancer where there's
• 26:28a group of patients now and.
• 26:29Unfortunately,
• 26:30it's still not the majority,
• 26:31but a growing group of patients who
• 26:33really get a tremendous benefit.
• 26:35And when I say that it's not
• 26:37just that it shrinks the cancer
• 26:38by a little bit or or leads to
• 26:40survival for some amount of time,
• 26:42but there's certain patients again,
• 26:44unfortunately,
• 26:44still a small fraction,
• 26:46but a a notable fraction where this these
• 26:48drugs can actually work for a really,
• 26:50really long time.
• 26:50And so I think we're at this
• 26:52important moment in kidney cancer
• 26:54where we now have these tools that
• 26:56are almost proof of concept that
• 26:58for a small group of patients.
• 27:00Were able to really, really,
• 27:02really good job of controlling their cancer,
• 27:05and for some of those actually
• 27:06doing so for really long time.
• 27:08Yeah,
• 27:08really these long term durable
• 27:10kind of can't cancer control,
• 27:12but there's still a large group of patients,
• 27:14unfortunately,
• 27:15probably still the majority of
• 27:16patients with advanced disease,
• 27:18for which these this long term control
• 27:20this long term benefit is not there.
• 27:22And so it's this proof of concept.
• 27:24We can do it,
• 27:25but we need to figure out how
• 27:26to do it for more people.
• 27:27And that's where I think the
• 27:28research is so important.
• 27:30Well, in the. The other question
• 27:32that springs to mind is,
• 27:34can you identify which patients are
• 27:35going to do well with immunotherapy
• 27:37and which patients are not?
• 27:40Absolutely, I think that's a an
• 27:42A critical critical question.
• 27:44I think you really hit the nail on the head.
• 27:46You know, I think for patients
• 27:48who are getting immunotherapy,
• 27:50we really need to study this.
• 27:51We need to understand where the patients
• 27:53that really do well and wine who are the
• 27:55patients for which the therapy fails them.
• 27:57That doesn't have the benefit it should and.
• 28:01And what's happening biologically then,
• 28:02and I think that gives us
• 28:04two pieces of information.
• 28:05One is exactly what you're talking about,
• 28:07which is the sort of term biomarker
• 28:09can we actually help to select
• 28:11patients and select drugs.
• 28:12Meaning we match the right
• 28:14drug with the right patient.
• 28:15That's a really important sort
• 28:17of goal of some of this work.
• 28:19The other bucket is,
• 28:20can we actually understand why
• 28:22certain tumors are resistant,
• 28:24and if we have that understanding,
• 28:25then in in our laboratory can we
• 28:27actually think of strategies,
• 28:28ways to overcome that resistance
• 28:29and bring benefit to more patients?
• 28:32Doctor David Braun is an assistant
• 28:34professor of medicine and medical
• 28:36oncology at the Yale School of Medicine.
• 28:39If you have questions,
• 28:41the address is canceranswers@yale.edu
• 28:43and past editions of the program
• 28:46are available in audio and written
• 28:48form at yalecancercenter.org.
• 28:49We hope you'll join us next week to
• 28:51learn more about the fight against
• 28:53cancer here on Connecticut Public
• 28:55radio funding for Yale Cancer Answers
• 28:57is provided by Smilow Cancer Hospital.