Close to 65,000 people will be diagnosed with kidney cancer in the U.S. this year, with over 90% of those being classified as renal cell carcinoma (RCC).
The majority of patients will be diagnosed before the disease has spread beyond the kidneys – about 65% – but one-fifth or more of those are expected to experience a recurrence or spread of the disease in the years following surgery. About 16% of RCC patients are diagnosed with metastatic disease from the beginning (source: National Cancer Institute Surveillance, Epidemiology, and End Results Program, 2018).
Treatment is rapidly evolving for patients at all stages of the disease. Standard of care for non-metastatic RCC is surgery, either partial or radical nephrectomy, but since last year, controversy exists on what to do next to prevent recurrence – treat with targeted therapies or monitor with active surveillance?
For those with metastatic disease, having either a partial or radical nephrectomy had been the standard of care as well, but with the advent in 2005 of targeted treatments, the therapeutic landscape for these patients began to change. And now, research presented this year, suggests that many patients may be able to skip surgery all together, that treatment with a targeted therapy alone may be just as good.
Finally, immunotherapy has become increasingly important in the treatment of RCC, but at what cost? Checkpoint inhibitors have become a major modality for advanced disease, and clinical trials are underway to evaluate the agents in the adjuvant setting to prevent recurrence. They can be markedly effective for some patients, but costs for the treatments are steep. Questions remain about whether the benefits are worth the high cost.