Clinicians may be able to improve survival rates among patients with renal cell carcinoma (RCC) by tailoring treatments according to whether patients have low-, intermediate-, or high-risk malignancies, study findings suggest.

This personalized approach is based on an integrated staging system developed at the Jonsson Comprehensive Cancer Center at the University of California-Los Angeles (UCLA). The system enables physicians to identify risk categories for localized and metastatic disease based on the chance of recurrence. Using this system in a study of 1,492 RCC patients who underwent nephrectomy, researchers established survival rates based on disease risk level.

For localized disease, the five- and 10-year disease-specific survival (DSS) for low-, intermediate-, and high-risk patients was 97% and 92%, 81% and 61%, and 62% and 41%, respectively. For metastatic disease, the five- and 10-year DSS for these risk groups was 41% and 31%, 18% and 7%, and 8% and 0%, respectively. The investigators reported their findings in Cancer (2008;113:2457-2463). In their paper, they identify which treatments benefited which patients according to their risk group.

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Nearly one quarter of patients with metastatic kidney cancer had long-term treatment responses (five- to 15-year survival). With conventional approaches, less than 5% of patients with metastatic disease have long-term survival or a cure.

“This is the most important work we’ve done out of the kidney cancer program at UCLA,” said senior author Arie Belldegrun, MD, professor of urology at UCLA’s David Geffen School of Medicine.

“We outline the foundation for personalized kidney cancer therapy. We have shown that not all kidney cancer patients are the same, not all localized kidney cancers are the same, and not all metastatic kidney cancers are the same.”

The investigators demonstrated that patients with low-risk, localized tumors could be treated with surgery only and expect to have excellent outcomes, sparing them from having to undergo radiation or immunotherapy. Patients with high-risk localized disease, however, might require additional adjuvant therapy to prevent recurrence.

For patients with advanced disease, “newer targeted and potentially less toxic treatments should be at least as effective as those achieved with aggressive surgical resection and immunotherapy,” the authors concluded.

In their study, 7% of patients with metastatic disease who received immunotherapy had a complete response and a median survival of more than 120 months. Another 15% had a partial response and median survival of 43 months, 33% had stable disease and a median survival of 39 months, and 45% had progressive disease and median survival of 12 months.