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Fresh Hope Of Longer Survival For Kidney Cancer Patients – Metastatic Renal Cell Cancer Could Become A Chronic Rather Than Fatal Disease

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New drugs could help patients with advanced kidney cancer live much longer, experts claimed this month. Renal cell cancer, the commonest form of kidney cancer, affecting around 200,000 people worldwide each year, is currently difficult to manage in its advanced or metastatic stage (mRCC). Around a third of patients already have metastases when their cancer is diagnosed and their prospects of surviving more than a year or two have been bleak. Only a small percentage survives five years.

Now, a publication issued by the European Association of Urology (EAU) at the association’s annual meeting in March 2007, gives cause for hope. Experts in the treatment of mRCC, writing on the latest research findings, say that new, more effective, drugs have the potential to change the outcome of the disease radically. “We are in a position to change the natural history of this disease by transforming mRCC into a chronic disease” say the authors led by Professor Jean-Jacques Patard of Rennes University Hospital, Rennes, France.Their optimism stems from the development of small molecule drugs, swallowed as tablets, that are able to target receptors on and within cancer cells, inhibiting kinases (specialised enzymes) with the effect of arresting growth and depriving tumours of their blood supply. Much more work needs to be done to identify combinations of drugs that will put cancers into complete remission and prevent metastases recurring after surgery, the authors warn, but they say there are already two drugs that can make a major contribution beyond the standard treatments already used.Sunitinib (Sutent) manufactured by Pfizer was shown in a large phase III clinical trial of 750 mRCC patients with a low or intermediate risk to extend the time period before their disease progressed. Patients received either sunitinib or the standard therapy of interferon (IFN) alpha. Those receiving sunitinib more than doubled the length of their progression-free survival to 11 months compared to 5 months for IFN alpha. Their risk of dying or seeing their disease worsen was more than halved (58%). Tumours were more than five times more likely to shrink when treated with sunitinib than with IFN alpha. Response rates were 31 per cent versus 6 per cent. These results were highly statistically significant. What is more, patients felt their quality of life was improved more by sunitinib than IFN alpha and a smaller number of them experienced side effects causing treatment to be withdrawn. Although the results are not yet available to show how treatment affects length of survival overall, the data are encouraging.The results of the sunitinib trial have meant that the drug is now officially approved in Europe and America for first-line use in mRCC. Within two months of Pfizer receiving permission to promote the drug in this indication, the EAU has already advocated its use as first-line therapy in its latest guidelines. Professor Kurt Miller, a member of the German Working Group for Urological Cancer, who is based in Berlin said the EAU’s first-line sunitinib recommendation was an important step in getting the therapy acknowledged as the standard of care for mRCC therapy across Europe. Physicians in some European countries are likely to encounter reluctance in willingness to fund the treatment costing around 3000 euros per patient per month but Professor Miller said: “There is strong clinical evidence to support its use.”The second major contribution highlighted, concerned another targeted therapy, temsirolimus, in development by Wyeth as Torisel. The drug is a specific inhibitor of M tor (mammalian target of rapamycin), a kinase that plays a key role in cell cycle regulation. A phase III study of mRCC patients with poor prognosis, comparing first-line temsirolimus with IFN alpha, showed temsirolimus extended median survival by 49 per cent (10.9 vs 7.3 months). The product is not yet licensed but when it receives marketing approval the EAU guidelines recommend that clinicians should consider it for first-line treatment of poor-risk mRCC patients.Further research is already in progress to explore the optimal combinations of targeted therapies and how they can best be used to help patients keep their cancers suppressed for much longer than has been possible to date. More data is likely to be available later this year.(Source : European Association of Urology (EAU) Annual meeting : Benjamin Franklin Medical Centre : April 2007.)


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Posted On: 9 April, 2007
Modified On: 16 January, 2014

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