October 18, 2023

Innovating care for kidney cancer

Kidney cancer is among the malignancies that often go undetected in earliest stages because it does not cause noticeable symptoms.

“Unfortunately, kidney cancer can be a very sneaky disease,” according to Dr. Hamid Emamekhoo, a medical oncologist with UW Health | Carbone Cancer Center who specializes in genitourinary cancers. “So most patients might not notice any specific signs of kidney cancer when it starts.”

In fact, oftentimes kidney cancer is discovered when a patient receives medical imaging for a different purpose, such as CT scans of the chest, and the provider notices a large mass on a kidney that was partially imaged in the scan. Despite this, Emamekhoo said kidney cancer can be slow to metastasize, or spread to other areas of the body, which provides a better treatment outlook.

“It can turn into a sizeable mass, up to 7 or 8 centimeters, but it remains only in the kidney and doesn’t spread to other places,” he said.

Kidney cancer, also called renal cell carcinoma, is seventh most commonly diagnosed cancer in the U.S., with almost 82,000 new cases each year. The disease is most common in older adults, with the median age of diagnosis at 64 years old, and men are diagnosed at twice the rate as women.

Risk factors of the disease can include smoking and some environmental toxin exposures, though Emamekhoo said the majority of kidney cancer cases are spontaneous without a known cause. Blood in the urine can be a warning sign of kidney cancer, as well as other genitourinary disorders, so seek medical attention if that occurs.

“If an adult, especially a man, has blood in their urine, it always needs attention and evaluation,” Emamekhoo said. “Of course, it might be as simple as a kidney stone, but we have to rule out kidney or bladder cancer as a cause.”

Because this type of cancer is slow to spread, 65% of cases are diagnosed while the cancer is still contained to the kidney. Surgical removal is the primary treatment, and Emamekhoo said those patients are screened regularly to check for any new appearance of metastatic disease. Of patients treated with surgery, about half could experience a recurrence of their cancer, which is why an adjuvant course of immunotherapy is often used after surgery to reduce the risk of recurrence for patients who have high-risk pathological characteristics in their surgical specimen.

For those with recurrent kidney cancer or patients who are diagnosed at a metastatic stage, treatment includes combination regimens such as immunotherapy as well as targeted therapy drugs that block the pathways that fuel cancer cell growth.

“We have learned that combined modality approaches, such as the combination of two immunotherapy drugs, or one immunotherapy and one targeted therapy drug, are more effective than treating patients with a single agent,” he said. “And for that reason, a combination regimen is the most effective and recommended systemic treatment for patients.”

Emamekhoo is partnering with several Carbone Cancer Center researchers to develop a blood screening technique that can detect kidney cancer cells in a patient blood sample. Compared to traditional needle biopsy, this could provide a less-invasive and more thorough method of tracking disease progression and treatment effectiveness for metastatic kidney cancer patients.

“(The blood biopsy) is showing me the overall cancer picture and a better and clearer view of the cancer compared to a snapshot and one little piece of tissue obtained from one metastatic site,” he said.

Emamekhoo is encouraged by their pre-clinical findings, and they are testing this approach in several ongoing clinical trials to verify their use in routine clinical care.