Hello, I am Dr. Mrugal Doshi, a specialist in Medical and Hematological Oncology (D.M. in Medical Oncology) at Aariv Cancer Care, recognized as one of the Top cancer hospital in Vadodara. Kidney cancer, especially metastatic renal cell carcinoma (mRCC), can be challenging to treat. Over the years, advances in immunotherapy and targeted therapy have significantly changed how we approach this disease.
Understanding Metastatic Renal Cell Carcinoma
Renal cell carcinoma (RCC) is the most common form of kidney cancer in adults. When the cancer spreads to other organs, it is called metastatic renal cell carcinoma (mRCC). Patients may experience:
- Blood in urine (hematuria)
- Pain in the side or abdomen
- Fatigue and unintended weight loss
- Swelling in the legs
- Persistent fever
- Breathing difficulties if the lungs are affected
- Bone pain if cancer spreads to bones
Often, early RCC does not show symptoms, so diagnosis may occur during routine scans.
How We Diagnose mRCC
At Aariv Cancer Care, we use a combination of tests to diagnose and plan treatment:
- Imaging: CT scans, MRI, and ultrasound to check tumor size and spread.
- Blood tests: To check kidney and liver function, blood counts, and overall health.
- Biopsy: In selected cases, to confirm the cancer type and guide therapy.
What Is Cytoreductive Nephrectomy ?
Cytoreductive nephrectomy (CN) is surgery to remove the main kidney tumor. This helps reduce the tumor burden, improve symptoms, and can make systemic therapies more effective.
In the past, CN was often combined with cytokine therapy. Today, with immune checkpoint inhibitors and targeted therapies available, we carefully plan when and how to perform CN based on each patient’s situation.
Timing of Surgery
- Upfront Surgery (Immediate CN):
- For patients with good health and few metastatic sites.
- Can quickly reduce tumor size and relieve symptoms.
- Systemic Therapy First (Followed by CN):
- For patients with intermediate or high-risk disease or extensive metastasis.
- We start with immunotherapy or targeted therapy to see how the tumor responds.
- Surgery may follow if the patient responds well.
Role of Immune Checkpoint Inhibitors
Immune checkpoint inhibitors (ICIs) are drugs that help the immune system fight cancer.
They have changed how we treat mRCC:
- Nivolumab: Blocks PD-1 to help the immune system target cancer.
- Ipilimumab: Blocks CTLA-4 to activate T-cells against the tumor.
- Pembrolizumab: Another PD-1 inhibitor effective in kidney cancer.
Combining CN with ICIs can improve survival for selected patients. The choice of timing depends on the patient’s overall health, tumor burden, and treatment response.
How We Select Patients for CN
Not every patient benefits from surgery. Proper patient selection is critical:
- Good performance status
- Limited metastasis
- Healthy organs and manageable comorbidities
- Response to initial systemic therapy
We also use risk assessment tools like IMDC, MSKCC and MDACC criteria to guide decisions. However, these tools are only part of the picture. Each patient is unique, and treatment must be personalized.
Prognostic Factors and Biomarkers
Some factors can affect outcomes after CN:
- Large tumor burden
- Poor performance status
- Abnormal blood markers like high lactate dehydrogenase (LDH)
We are also studying biomarkers to predict response to immunotherapy:
- PD-L1 Expression: May indicate better response to drugs like nivolumab.
- Tumor Mutational Burden (TMB): Higher mutation load can sometimes improve response, though more research is needed.
Prognostic Factors and Biomarkers
While most research is on clear-cell RCC, CN may benefit patients with non-clear-cell types too. We make decisions based on the patient’s overall health and tumor behavior.
Benefits and Limitations
Benefits of CN:
- Reduces tumor size
- Improves symptoms
- Enhances systemic therapy effectiveness
Limitations:
- Surgical risks (bleeding, infection, complications)
- May not help patients with high-risk factors
- Limited predictive accuracy of risk models
Why Choose Aariv Cancer Care, Vadodara
At Aariv Cancer Care In Vadodara, patients with metastatic renal cell carcinoma receive comprehensive care combining surgery and systemic therapies.
- Expert Oncologist in Vadodara: Aariv Cancer Care Led by me, Dr. Mrugal Doshi, specializing, Cancer doctor in Vadodara, in medical and hematological oncology.
- Personalized Treatment Plans: Combining CN with immunotherapy or targeted therapy based on individual patient needs.
- Advanced Facilities: High-quality imaging, surgical suites, and supportive care.
- Patient-Centered Approach: We focus on improving both survival and quality of life.
Conclusion
Cytoreductive nephrectomy remains an important treatment option for carefully selected patients with metastatic renal cell carcinoma. Combined with immune checkpoint
inhibitors, it can improve outcomes and quality of life.
- Upfront CN is suitable for patients with good performance status and limited metastasis.
- Systemic therapy first is better for patients with higher risk or extensive disease. At Aariv Cancer Care, Vadodara, we tailor every treatment plan to each patient’s needs. If you or a loved one is diagnosed with metastatic renal cell carcinoma, consult an experienced oncologist to explore the best options.
At Aariv Cancer Care, Vadodara, we tailor every treatment plan to each patient’s needs. If you or a loved one is diagnosed with metastatic renal cell carcinoma, consult an experienced oncologist to explore the best options.
