About 73,820 new cases of kidney cancer are forecast to be diagnosed among Americans in 2019, and nearly 14,770 can be expected to die from the disease. Cancer of the kidneys, like any cancer, is most curable at an early stage. However, the majority of early-stage tumors do not present symptoms. In fact, many cases are discovered “by accident” during imaging for a range of other health conditions, by which point tumors have proceeded to advanced stages. But researchers in the United Kingdom recently identified a protein marker in the blood that could act as warning beacon five years in advance of the current standard of detection. When the molecule, called KIM-1, occurs in greater concentrations, the scientists found, the higher the risk is of developing kidney cancer. KIM-1 levels were also found to be linked with poor survival of the disease, as those with the highest levels in their blood were less likely to live. In the future, the scientists think that testing for blood KIM-1 levels could be used alongside imaging to confirm suspicions of kidney cancer, or help to rule out the disease. KIM-1, short for “kidney injury molecule-1,” is a type-1 transmembrane protein and is not normally present, but is expressed with injury. KIM-1 has proved to be an outstanding indicator of kidney injury in rat trials, outperforming blood urea nitrogen and serum creatinine levels as predictors of histopathological changes in the proximal tubule (part of the kidney’s filtration structure) in response to many pathophysiological states or toxicants. Previous to the British research, studies in humans strongly suggested that tissue expression and urinary excretion of KIM-1 are specific markers of injury, as well as predictors of outcome. “This work is a big step forward,” said Dr. David Muller of Imperial College London. “KIM-1 is the only blood biomarker shown prospectively to distinguish between people at high and low risk of kidney cancer. The next steps are to look more closely at whether KIM-1 levels can help detect tumors that have a good prognosis.” Professor Charles Swanton, Cancer Research UK’s Chief Clinician, adds: “The potential of blood tests for the detection and monitoring of cancers is becoming increasingly apparent, and this work offers further evidence that they could become powerful tools in the clinic. There is a pressing need to shift kidney cancer diagnoses towards earlier stages, when treatment is more likely to be successful, and this promising research is progress towards that goal. This work is still in early stages, so prospective studies of larger populations are needed before this approach could be widely adopted.” “It’s now crucial to understand more about how KIM-1 could be incorporated into patients’ treatment,” comments Dr. Rural Bhatt, a senior author based at Harvard Medical School. “We’re excited about progressing this important work further and testing whether KIM-1 levels could help identify patients who may benefit from additional treatment after surgery, and therefore potentially improve their outlook.” Cancer markers in the blood comprise an expanding and exciting field. Such NFCR fellows as Daniel Haber, Ph.D., and Wei Zhang, Ph.D., are leading figures. More advances seem to be around the corner, […]

Surgery is one of the oldest treatments for cancer. Even as research and technology have progressed, surgery has remained an excellent choice of treatment. Kidney cancer, whose attention we are called to especially during the month of March, is often treated with a surgical process called a partial nephrectomy. A partial nephrectomy means that the tumor is removed whilst sparing the kidney. A partial nephrectomy is a complex surgery that can only be done at an early stage. As most cases of kidney cancer are identified at early stages, the surgical procedure is the most common form of treatment. Unfortunately, some patients find that a nephrectomy may severely threaten their health. Individuals diagnosed with heart disease, kidney disease or other comorbidities may not be viable patients for the surgical procedure. Such diseases could greatly negatively impact the life expectancy of a patient who undergoes a nephrectomy. Being that small kidney tumors may be benign, patients that are not suitable candidates may avoid surgery by undergoing active surveillance. Active surveillance allows medical professionals to monitor the tumor. Periodic CT scans make it possible for medical professionals to track the growth of the tumor and delay surgery for at-risk patients. While a worthwhile effort, active surveillance is vastly underutilized. This is due, in part, to the lack of guidelines illustrating when to act if surgery is in fact needed. Medical professionals are often not equipped with proper decision-making tools when it comes to weighing the risk of comorbidities against surgery. At the beginning of this year, however, researchers developed a model that may bring more value to the decision-making process. New York University’s Stella Kang, M.D., and her teammates there, Memorial Sloan Kettering Cancer Center and Massachusetts General Hospital identified the need to effectively weigh the risks. They developed computer-based simulations to measure the impact of various methods of treatment for kidney cancer patients. Each of the simulations involved a patient with a small kidney tumor. The simulations accounted for variables such as severity of kidney disease and other comorbidities. After one million simulations, Dr. Kang and her research team discovered that partial nephrectomies were rarely the most effective way to extend the life expectancy in patients with chronic kidney disease. Personalized strategies, including active surveillance, extended life expectancy by more than two years when compared with surgery. The results from Dr. Kang’s study may greatly impact the decision-making process in clinical settings. Simulations using the patient’s data could aid in identifying the correct treatment for an individual. While the simulation does not suggest one specific course of action, it does allow doctors and patients to examine the risks of treatment options. In addition to benefiting individuals battling kidney cancer, these results could impact additional clinical areas. It is a great demonstration of the clinical significance in simulations. Simulations are not limited in time and expense unlike most clinical trial studies. They also offer individualized outcomes which cannot be provided by studies. References: • https://www.cancer.net/cancer-types/kidney-cancer • https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/surgery/about • https://pubs.rsna.org/doi/10.1148/radiol.2018181114 • https://www.sciencedaily.com/releases/2019/01/190115103533.htm

This month is Kidney Cancer Awareness Month, and March 8, is World Kidney Day. In this National Foundation for Cancer Research blog post, we will look at recent scientific advances in the battle against the most common form of the disease: Renal Cell Carcinoma (RCC). In 2018, just under 64,000 people will be diagnosed with kidney cancer in the United States. This staggering statistic places kidney cancer as one of the top 10 common cancers in the U.S. Luckily, we are starting to see groundbreaking medical intervention strategies for people suffering from RCC, its most prevalent iteration. We are also now able to identify major lifestyle approaches for RCC and other cancer risk mitigation efforts. Intervention Emerging research coming out of the Georgetown Lombardi Comprehensive Cancer Center has people in the RCC community excited. This research shows promising antitumor results with combining immunotherapy agents with anti-angiogenesis agents without adverse effects. This approach has been taken before but with much less success, due to the toxicities which developed from the combined treatments. However, the combination of axitinib (Inlyta) and pembrolizumab (Keytruda) has now shown significant antitumor results in people with advanced kidney (also known as renal) cancers, without the toxicities that were previously experienced. Axitinib is a small molecule tyrosine-kinase inhibitor which inhibits a protein growth factor that is crucial for the growth of new blood vessels (angiogenesis). This helps shrink tumors by reducing their nutrient supply through the bloodstream. Pembrolizumab is an antibody which binds to our immune cells and allows them to better recognize cancer cells as “foreign” and pathogenic. Often times, cancer cells have proteins which block our immune system cell’s recognition of cancer cells as pathological. With this immunotherapy agent, the immune system can identify and attack cancer cells more effectively. These two drugs combined are proving to be safer, more effective and better tolerated for people with advanced kidney cancers. New immunotherapy agent and anti-angiogenesis agents, including atezolizumab and bevacizumab, are also being actively researched. The current standard treatment option for patients with early detected lung cancer and comorbidities (other medical conditions), has now been proven to be effective and safe for those with RCC. This treatment is stereotactic ablative radiotherapy (SABR). Stereotactic ablative radiotherapy (SABR) is a highly focused radiation treatment that gives an intense dose of radiation concentrated on a tumor, while limiting the dose to the surrounding organs. The recent research in the use of this treatment towards RCC has provided important information showing that it is effective, safe, well-tolerated and can preserve kidney function. Kidney Cancer Prevention Although treatments for kidney cancer are swiftly progressing, it is still of great importance to focus on prevention. The major risk factors for kidney cancer are smoking, obesity and high-blood pressure. Interestingly, there is a question of if antihypertensive medications (which reduce blood pressure) may actually be a risk factor for kidney cancer. The evidence is polarized and inconclusive in this area. Regardless, it is advised to address these three areas of health with a holistic approach. Finding the time to exercise, reducing stress, improving diet and taking the necessary steps to quit smoking will […]