Understanding Recent Treatment Advancements in Kidney Cancer Care

Dr. Ravi Munver, the vice chair of Urology at John Theurer Cancer Center and professor of Urology and chief of Minimally Invasive and Robotic Surgery at Hackensack University Medical Center in Hackensack, New Jersey, sat down for an interview with CURE to discuss progress in kidney cancer care.

“The last couple of decades have [brought significant progress] in terms of our treatment of advanced and metastatic kidney cancer,” he emphasized, adding that, “These therapies are allowing these patients to survive longer.”

During the interview, he expanded on minimally invasive approaches and surgical options in kidney cancer, as well as the role of targeted therapies for patients with this disease.

CURE: Can you provide an overview of the current landscape of kidney cancer treatment?

Munver: Kidney cancer treatment has evolved over the last few decades, and there has been a huge paradigm shift in how we treat it. For example, not all kidney cancers need to be treated. We are definitely looking more towards active surveillance for small renal masses that don't demonstrate growth.

We are also using renal mass biopsies, where we can sometimes tell if a tumor is benign versus cancerous. If a benign tumor is found, it does not need to be intervened upon with surgery or any other therapy. We then look at surgery for those cancers that we suspect are progressive, which means for patients who would benefit from having their tumors removed rather than waiting for these tumors to perhaps spread and metastasize.

The paradigm shift has really led us from doing maximally invasive surgery through big incisions to using minimally invasive surgeries with robotics. We can do both multi-port and single-port robotic surgeries, which means using multiple small keyhole incisions or one small keyhole incision, where we can remove tumors with the goal of preserving the kidney.

How have minimally invasive approaches and robotic surgical techniques changed outcomes for these patients?

Minimally invasive surgery has been the hallmark of how surgery has evolved, benefiting patients in terms of their recovery and overall quality of life. The introduction of laparoscopic, or keyhole, surgery has progressed to robotic keyhole surgery. Through very small incisions, we can insert instruments with a telescopic camera to look inside the abdomen where the kidney is located and focus on removing the tumors or the entire kidney itself.

In addition, we are now utilizing three-dimensional anatomical models that are created with artificial intelligence from patients' CT scans or MRIs. These allow us to do preoperative planning and help with intraoperative navigation. During surgery, this means we can use these three-dimensional models to understand where the tumor is in the kidney, how deep it penetrates, and if it's involving other structures we need to be concerned about so we can remove the tumor and preserve the kidney.

Therefore, minimally invasive surgery and these three-dimensional imaging modalities have allowed us to offer the majority of our patients a partial nephrectomy. Partial nephrectomy means removing just the part of the kidney with the tumor itself and preserving the rest of the kidney so that patients can have a better quality of life and minimize their risk of needing dialysis in the future.

Looking towards another approach, can you discuss the role of targeted therapies and immunotherapies in managing advanced or metastatic disease?

The last couple of decades have been exciting in terms of our treatment of advanced and metastatic kidney cancer. Previous to the development of targeted therapies and immunotherapies, we would typically tell patients that if they had metastatic disease, they only had a year, or a few years left of survival before their cancer would really take their lives. Because of targeted therapies, which are oral therapies that focus on inhibiting, minimizing or slowing cancer cell growth, and immunotherapies, which use the body's immune system to attack cancer cells, we are able to offer patients a very good quality of life.

Chemotherapies and radiation therapies don't work very well for prolonging someone's life if they have advanced or metastatic cancer. However, these targeted therapies and immunotherapies can be used individually or in combination. With each passing year, more medications for targeted therapies and more medications for immunotherapies are being developed and are allowing patients a pretty good quality of life because they don't have significant side effects, as patients will have with chemotherapy agents. These therapies are allowing these patients to survive longer.

Transcript has been edited for clarity and conciseness.

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