Q. Two years ago my husband had his right kidney removed due to renal cell carcinoma. There was no chemotherapy done after surgery because the doctors said it wasnt necessary. One year later, spots were found on his lungs.
He was given Megace for treatment. Now, nine months later, three lesions have been discovered on his brain, and the spots on his lungs have grown fractionally. Is this a metastasis of the renal cell cancer? I'm also wondering why chemotherapy wasnt done after the first surgery and why wasnt it performed immediately on discovery of the lung lesions. Do you have any ideas? Thanks. Debra
Dear Debra,
I am sorry to learn of the difficulties that your husband is experiencing. Renal cell carcinoma is not reliably responsive to radiation or chemotherapy.
If there is no evidence of local spread at the time of the initial surgery, there is no standard additional therapy given. With proven spread (metastases) over time, some oncologic urologists would attempt surgical removal of these while others would consider chemotherapy (assuming that he could tolerate either).
Although there are no known right drugs for this condition, there are several experimental chemotherapy protocols for which your husband might qualify.
Q. My father was diagnosed with renal cell carcinoma about four years ago resulting in a nephrectomy (removal) of the affected kidney.
He had been a heavy smoker for most of his life and had quit one year prior to the diagnosis.
Two years later we were told that the cancer had spread, via the bloodstream, to his lungs and bones.
The only treatment that he is receiving is radiation therapy to control pain in his bones along with prescribed pain-killers (morphine-Kapanol), bone strengthening drugs and paracetamol (Panadol).
The lesions in his lungs are growing at a slow rate. He has very little shortness of breath now. However, his bone pain has spread.
Could you please provide information about treatments, alternative or conven-tional, that could prolong life. Also, do you have any information about similar cases that may help my father? I need a reply as soon as possible because hope and time are running out. Thank you and hope to hear from you soon. Bill
Dear Bill,
Metastatic renal cell carcinoma (mRCC) is a difficult disease to cure. Many of the treatment modalities have considerable morbidity associated with them. The only agent currently approved by the FDA is Interleukin 2 (IL-2).
It is a form of immunotherapy that primes the bodys immune system to fight cancer. The biggest problem with IL-2 is its toxicity, which includes clinically significant hypotension.
Patients who receive high doses of this treatment must be hospital-ized. IL-2 is toxic to the heart, kidneys, skin and mucous membranes, liver, gas-trointestinal tract and blood cells. Ironically, there is also a risk of infection.
There have been studies where patients immune cells have been treated with IL-2 outside of the body to supercharge them, before being returned to the patient. Although promising in both concept and early clinical trials, adoptive immunotherapy has not yet proven beneficial in patients with mRCC.
With respect to your father, patients with mRCC who are considered to have a good prognosis are those with the following conditions:
Disease-free interval of more than two years
Solitary lung or bone metastasis?
Normal performance status.
These patients are treated aggressively with local therapy (surgery or radiation) for long-term palliation. Other patients who do not fit into this category have a poor prognosis and receive palliative radiation therapy or surgery for pathologic or impending fracture.
I suggest that you consult with your father's physicians in a multidisciplinary set-ting to discuss the prognosis, goals and any treatment protocols that may suit your dad.
