10 Things to Know About Stage 4 Kidney Cancer

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Kidney cancer has reached stage 4 status when the cancer has grown outside of the kidney or has spread to other parts of the body, such as distant organs or lymph nodes. Because kidney cancer often does not have obvious symptoms in its early stages, it may not be discovered until it has spread. New therapies are being developed, and some may even offer the potential for a cure. For now, here are some things you should know about stage 4,or advanced, kidney cancer.


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New possibilities on horizon

Treatment at stage 4 will depend on how extensive the cancer is and what your overall health is like. The good news is there are many research studies and clinical trials underway to find new and better ways of combating stage 4 cancer. Most studies and clinical trials for kidney cancer are focused on targeted therapy and immunotherapy drugs.


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The FDA is approving new therapies every year

In recent years, there has been a steady development of new drugs being approved by the U.S. Food and Drug Administration for kidney cancer. Since 2016, the FDA has approved at least six new drugs and therapy combinations specifically for kidney cancer. Most of these therapies are for patients with advanced kidney cancer, those who have a poor prognosis because of risk factors for their type of cancer, or are at high risk of cancer recurrence.


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Interleukin-2 is a longstanding therapy with severe side effects

Treatments have come a long way since 1992, when the FDA approved interleukin-2 (IL-2). IL-2 was the first systemic therapy of its kind. It uses cytokine, a cellular hormone produced by white blood cells, to destroy tumor cells. IL-2 is still offered, and can cure a small percentage of patients with metastatic kidney cancer, but the side effects can be severe, including serious infection, fever, heart attack, and bleeding. You may need to stay in the hospital during treatment.


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Podcasts can offer some answers

Many new and older therapies can benefit stage 4 patients by improving symptoms and helping them live longer. This reality was just one of the topics of conversation in a podcast by Charles Ryan, M.D., from the University of California at San Francisco and Brian Rini, M.D., a medical oncologist at the Cleveland Clinic who specializes in kidney cancer.


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There are more therapies on the horizon

“There’s a frantic wave of development of these [immunotherapy] drugs … in combination with some of our standard therapies,” Dr. Rini says during the podcast. The podcast is part of an ongoing series by Cancer.Net Podcasts and produced by the American Society of Clinical Oncology. The series offers patients and family members information on research, treatment, ways to cope, and other topics related to kidney cancer.


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Immunotherapy treatments offer hope

One recent development is the use of nivolumab and ipilimumab as frontline treatments for patients with advanced kidney cancer and intermediate and unfavorable risk features. In a statement that he emailed to HealthCentral, Eric Jonasch, M.D., a professor in medical oncology at the University of Texas MD Anderson Cancer Center, noted that the combination of these drugs has been shown to improve survival and response rates in patients.


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Yes, there are caveats

Dr. Jonasch cited several caveats about immunotherapy: Some patients required additional treatment to manage toxic side effects. Patients with favorable risk factors did significantly better on sunitinib, a targeted therapy that starves blood vessels feeding the cancer, Dr. Jonasch said. (Risk factors are features in a patient’s cancer associated with a worse prognosis or outcome.)


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Testing cancer vaccines

Doctors are also testing several cancer vaccines. One clinical trial is looking at making a vaccine from a patient’s own white blood cells and tumor cells to build the body’s immune response in order to kill cancer cells. That study is looking at the effectiveness of the therapy in treating patients with recurrent stage 3 or stage 4 kidney cancer.


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Survival rates may depend on risk factors

According to the American Cancer Society, the five-year survival rate for those with stage 4 kidney cancer is 8 percent. However, the UCLA Integrated Staging System found that in patients with kidney cancer that had spread to the lymph nodes or distant organs when it was first discovered, the five-year survival rate was 41 percent for the low-risk group, 18 percent for intermediate-risk group, and 8 percent for the high-risk group. Each group risk is based on type of disease and various staging grades. You can find out your grading by selecting relevant information at the UCLA website.


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There is always more to the story

As therapies and treatments are developed and improved, people are living longer with cancer. Between 1995 and 2015, death rates have dropped by about one percent annually. Also, survival rates measure statistics over a five-year period, so they may not reflect current or emerging treatments or therapies.