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Medical Edge Newspaper Column from Mayo Clinic

TOWARD NEW WAYS OF TREATING KIDNEY CANCER

DEAR MAYO CLINIC: I was recently diagnosed with renal cell carcinoma and am losing ground quickly. I can’t believe how fast this disease progresses, and how few treatment options there seem to be. I’ve been reading everything I can get my hands on, and nothing seems very encouraging. Interleukin-2 appears to be the most often-used therapy, but it has some real limitations. Is this really as good as it gets for treating a cancer that is so common? — Indianapolis

ANSWER: Renal cell carcinoma is indeed the most common form of kidney cancer, accounting for some 85 percent. And unfortunately, as you note, it can be highly aggressive, and there are few treatments available.

The primary treatment option for renal cell carcinoma patients, as you have discovered, is Interleukin-2 — the only U.S. Food and Drug Administration-approved drug that has been developed to treat that disease. IL-2 is an “immunotherapeutic agent,” which means it can stimulate the patient’s natural immune system to fight the cancer cells — at least, some of the time.

IL-2 prompts a useful response from the host’s immune system in 15 to 20 percent of patients treated. The vast majority of those who take IL-2 therapy are not significantly helped by it. Another significant limitation of IL-2 treatment is that it is relatively toxic and can further sicken the patient.

Research is revealing new and promising strategies to detect and treat kidney cancer. For example, at Mayo Clinic we recently discovered a potential molecular “marker,” which might help identify aggressive forms of the cancer at an early stage. As we recently reported in the Proceedings of the National Academy of Science, renal cell carcinoma patients who have higher levels of the molecule (called B7-H1) in their tumors are nearly five times more likely to die from the disease than patients with lower levels. B7-H1 has previously been shown to inhibit the immune system.

Here’s how this finding might work to benefit patients: If a tissue or blood test were developed to detect the B7-H1 marker, it could help guide therapy toward the most appropriate treatment options; only if a patient’s level were low would the aggressive IL-2 therapy be indicated.

In addition, the B7-H1 molecule may serve as a target at which to aim custom-designed new treatments. The thinking is that if we can disarm the molecule’s suppression of the immune system, maybe we can restore the patient’s natural abilities to fight renal cell carcinoma and make all kidney cancer patients good candidates for IL-2 treatment.

— Eugene Kwon, M.D., Urology and Immunology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Kidney Cancer
Appointment Information
More Information on Kidney Cancer

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The finding will help doctors correctly treat NMO — also known as Devic’s syndrome — sooner and more effectively. In some countries, misdiagnosis may be as high as 30 percent.
Early diagnosis is important because NMO is best treated differently from multiple sclerosis. Treatment requires immune suppressive medications in the first instance, rather than the immune modulatory treatments typically prescribed for MS. Therefore, a patient who has NMO, but is misdiagnosed with MS, may not receive optimal care at the earliest possible time. Early diagnosis is of paramount importance in reducing the severity of the disease’s course.

Additional Resources:
Neuromyelitis Optica
Appointment Information

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.