UNC logoEach year over 57,000 Americans are believed to face a diagnosis of kidney cancer. It however appears that another treatment option may soon be presented for patients with the advanced disease.

A pilot study at UNC Lineberger Comprehensive Cancer Center by physicians showed that therapy prior to surgery with the drug sorafenib could probably decrease the size of large tumors. Apparently without adding considerably to the surgery risks, it could be safely undertaken administered.

The physicians discovered that therapy prior to surgery with the mentioned drug could reduce the size of large tumors. Currently removal of the primary tumor which often includes the kidney is known to be the conventional treatment for patients with kidney cancer. This is irrespective of whether they disease may be localized to the kidney or has spread to distant sites.

The experts share that this broad spectrum thus comprises of patients with very large tumors who may not be ideal for surgical removal and also patients who may benefit from early systemic interventions, but who would also benefit from removing the kidney later. The man focus of the study seemed to have been on whether systemic therapy could be beneficial to patients before they undergo surgery to remove tumors. This study particularly addressed the question of therapy that seems to target the process by which tumors search and find new blood vessels to incite their growth.

Kimryn Rathmell, MD, PhD, a UNC Lineberger physician-scientist, an assistant professor of medicine at the University of North Carolina at Chapel Hill and the study’s principal investigator remarked “We found that primary kidney tumors responded to this therapy, shrinking up to 40 percent prior to surgery. What this means for kidney cancer patients is that their surgery may be less extensive and, we hope, can provide a better outcome for patients because of tumor shrinkage.”

As part of the study, scientists evaluated the safety and feasibility of preoperative treatment using sorafenib (Nexavar). They examined it in 30 patients with stage two or higher kidney cancer including metastatic disease. At the UNC Lineberger Comprehensive Cancer Center and at Rex Cancer Center in Raleigh, the patients received their treatment and took two daily oral doses of the drug for between four to eight weeks prior to surgery.

Nexavar which is manufactured by Bayer, is supposedly a targeted drug that may be used to treat advanced kidney cancer and a type of liver cancer. It seemingly avoids the growth of new blood vessels that fuel tumor growth. Sorafenib is alleged to be one among the class of new targeted agents approved by the FDA in 2005 for proof of benefit for patients with metastatic kidney cancer.

Using similar targeted therapy drugs, Sutent and Avastin two studies had been conducted earlier. However Rathmell’s study is said to be the largest one to investigate the use of Nexavar alone. It is reportedly also the first to explore the chances of pre-operative treatment in benefiting patients who do not have metastatic disease.

Study co-author Matthew Nielsen, MD, assistant professor of surgery in the UNC School of Medicine and a member of the UNC Lineberger urologic cancer program, commented, “This study is a major contribution to the field, demonstrating that Nexavar, is well-tolerated for pre-surgery use, with no increase in the rates of complications or difficulties recovering from surgical removal of the kidney. We are optimistic that this and future similar studies will ultimately allow us to offer, individualized treatment strategies for patients with this common and dangerous disease.”

“This study is promising. We saw significant reduction in the size of tumors using this drug, reducing the extent of surgery and making patient recovery less challenging. A larger study needs to be conducted to determine if preoperative systemic therapy improves outcomes in patients undergoing surgery for kidney cancer,” concluded Rathmell.

The successful integration of systemic therapy with what could traditionally be a surgical stage of the disease is another key aspect of this study.

The Feb. 16, 2010 online issue of the Journal of Clinical Oncology features these results.