Kidney cancer is an important topic for Central Europe because of the high prevalence of the disease in the region. This is primarily because the Czech Republic, for reasons which are still unknown, has the highest incidence of renal cancer in the world. Various aspects of this heterogeneous malignancy were discussed during dedicated sessions, including a video session, and poster presentations.
Dr. Michiel Sedelaar (Nijmegen, NL) talked about the indication for active surveillance (AS) in kidney cancer. He explained that, while partial nephrectomy is still the gold standard treatment, and an excellent curative option, there are reasons to investigate the possibilities of AS in specific patient groups.
The need for this treatment modality has increased over the years, due to the growing numbers of low-grade incidentalomas in elderly patients who often suffer from comorbidities which make them unfit for surgery. Sedelaar showed that the mortality rate in this particular patient group is low because small masses in the kidney tend to grow slowly and there is a very low risk that they progress to metastatic disease.
Sedelaar stressed that not all small lesions are harmless and partial nephrectomy remains the gold standard in young and otherwise healthy patients. Furthermore, the lack of biomarkers for kidney cancer makes it difficult to predict whether or not a tumour is aggressive.
Because of this, the role of renal tumour biopsy is also changing. Now that it has been established as a safe and accurate diagnostic tool, biopsy can be important in determining histology. Only for patients who are unfit for any type of active treatment is renal biopsy unnecessary. Alternatively, patients who are unfit for surgery can be treated with various ablative treatment. These techniques are still experimental and require a pre-treatment biopsy.
Dr. Dejan Bratus (Maribor, SL) discussed treatment options for patients with metastatic kidney cancer. Even though more randomised data is needed, surgery is indicated as a palliative approach, in combination with systemic therapy. Studies show that immunotherapy is more effective after nephrectomy. Surgery can even be curative if all metastases can be removed and should be offered to all patients who are fit enough for surgery.
Prof. Oliver Hakenberg (Rostock, DE) gave an overview of the latest developments in medical treatment of kidney cancer with tyrosine kinase inhibitors (TKI). A lot has been invested in research on TKI, but overall survival is not improved by these drugs. With the exception of soranifenib, axitinib and temsirolimus, which show some improvement in overall survival in patients with clear cell carcinoma, Hakenberg demonstrated that the new drugs mainly promote progression-free survival.
Combination treatment of TKIs is not useful, Hakenberg continued. Additionally, it is also very expensive and appears to have no benefit on quality of life. Hakenberg concluded that it is necessary to acknowledge the palliative nature of medical treatment in renal cancer and urologists need to take the high costs of the treatment into consideration.