Silencing a Silent Killer

Kidney cancer doesn’t make a lot of headlines. New drugs and immunotherapy treatments aim to keep it that way.

Correction: In the print version of this story, Edward J. Crane, M.D., was listed as retired. That is incorrect. He is actively practicing and accepting new patients.

Edward J. Crane, M.D.
Specialty: Oncology
TriHealth Cancer Institute

—as told to Lisa Murtha

Cancer survival rates in Ohio are actually better than they were, but the incidence of cancer in general in Ohio is higher than the national average. The instance of smoking in Ohio is unfortunately higher than the average [and] there’s a little bit higher sedentary lifestyle. I think it’s important to understand those risk factors, but not everybody who smokes or is overweight gets cancer. There are other factors that are completely out of people’s control.

Illustration by Coen Pohl

Part of the reason why people don’t hear about kidney cancer is the incidence of it doesn’t come anywhere close to breast cancer, prostate cancer, or lung cancer. But in the Greater Cincinnati region alone there are several hundred new cases of kidney cancer a year. The good news is, for the vast majority of patients with early-stage kidney cancer, [it] is curable with surgery alone. And just because you have kidney cancer doesn’t mean you have to have your whole kidney removed.

[For later stage kidney cancer], we used to use a barbaric version of immunotherapy. Patients were very ill with that—they developed kidney failure and all sorts of problems, and the likelihood of it helping was probably only about 20 percent. But now we have so many different treatments at our disposal—not just I.V. but oral treatments, and they’re so much better tolerated.

There’s a pill called Sunitinib that, taken for a year, demonstrated a delay in recurrence or progression but not an overall survival benefit yet. And then there are clinical trials evaluating checkpoint inhibitors to see if there would be an increase in cure rate by using those medications. Checkpoint inhibitors are a fairly new category of medications used for anti-cancer treatment that enhance the person’s own immune system to go after the cancer. Scientists have discovered that cancer—not just kidney cancer, but many different types of cancers—can put up a camouflage. As the body’s immune system goes past the cancer, the body doesn’t completely recognize that this is something that shouldn’t belong there and should be eradicated. Checkpoint inhibitors help take away the camouflage, allowing the body’s own immune system to go after the cancer. It’s not chemotherapy; it’s immunotherapy, which is pretty exciting.

We know immunotherapy works incredibly well to help patients who have stage IV or metastatic kidney cancer. I have a young gentleman who I’m caring for right now who received a couple different treatments that really did not help, [but] fortunately now the immunotherapy is maintaining good control over the disease in him and it’s done so for just over a year.

We have come a long way in our treatment of kidney cancer. I completed my fellowship 12 years ago—12 years isn’t that long—and during my fellowship we didn’t have all these things. [Now] there are patients who can live with metastatic disease for years and still enjoy time with their family and have a good quality of life, and that’s wonderful.

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