Featured Clinical Research
The incidence of kidney cancer has nearly tripled in recent years, an increase that is believed to be due to the incidental detection of very small tumors. These are often diagnosed when patients undergo diagnostic exams for other conditions. The standard treatment for kidney tumors, even tiny ones, has been surgery to remove the kidney, or a portion of it. However, this approach has not changed the number of patients who die from kidney cancer each year. “It’s likely that most of these small tumors wouldn’t have caused harm or death, so the thought is that we are over treating kidney tumors,” said urologist Dr. Brian Shuch.
A newer approach to treating small kidney tumors is to use active surveillance. This approach is routinely used in such conditions as prostate cancer. Active surveillance in kidney cancer is a recognized option by the American Urologic Association. This approach involves closely monitoring the tumor with diagnostic imaging. If there is growth, treatment is recommended prior to the tumor reaching a size considered no longer safe for observation. This strategy may eliminate the need for surgery in a large number of patients without compromising safety.
Dr. Shuch is conducting a clinical trial for patients with small clear cell kidney tumors (the most common type of kidney tumor) to determine if there are markers that can predict which patients will eventually need surgical treatment. The study involves active surveillance and periodic high quality imaging scans. Participants undergo a biopsy to confirm the presence of a clear cell renal tumor and to rule out aggressive tumor characteristics that would favor treatment. The tumor biopsy will allow later genetic characterization of the tumor. The genetic testing will not affect the treatment for that particular patient but may help researchers identify biomarkers in future patients to predict who should undergo immediate treatment.
This personalized approach to treating kidney cancer may have several advantages. Although some patients with small kidney tumors eventually require treatment, most do not. Identifying biomarkers that predict the future behavior of a tumor may help increase the use of active surveillance and help patients avoid unnecessary surgery. As the kidneys are vital organs, there are adverse health risks associated with all forms of surgery, including kidney dysfunction that can lead to cardiovascular disease. “The data suggest that in older patients you could be doing more harm than good,” said Dr. Shuch.
Study participants are monitored for three years. If the tumor reaches 3 centimeters in size, surgery will be recommended. However, it’s important to know that if patients become anxious they can decide at any point to undergo treatment at Yale or elsewhere.
“There is an epidemic of these small renal tumors that are invariably treated and for the most part treatment is unnecessary,” said Dr. Shuch. “A personalized medicine approach that uses markers to predict which patients actually need treatment may limit the significant harm associated with overtreatment.”
If you would like to enroll in this study or would like more information, contact Amanda Ralabate at 203-789-3131 or Angel Rivera at 203-737-2074.