For many years, doctors did not have an effective tool to fight advanced kidney cancer. Interferon alpha administered to patients did not extend their survival time, but only slightly improved their condition at the beginning of treatment. Currently, six so-called targeted, molecularly targeted drugs, but only one of them is reimbursed in Poland.
Every day 11 Poles are diagnosed with kidney cancer. Seven of them die because of him. Most of the patients are men, who get it twice as often as women. According to the National Cancer Registry, last year kidney cancer was diagnosed in about 2,5 thousand. men and 1,7 thous. women. It accounted for 3,8 percent. all cancer cases in men and 2,6 percent. in women.
– In terms of the number of cases, we do not differ from the European average. On the other hand, the number of deaths puts us in third place in Europe – says prof. Cezary Szczylik, head of the Oncology Clinic at the Military Medical Institute in Warsaw. Last year, 1574 men and 989 women died of kidney cancer, which is 3% and 2% respectively. all cancer deaths.
The cause of kidney cancer has not been fully recognized. According to scientists, an important role in the development of this disease may be played by both genetic factors and a high-fat or high-protein diet, obesity (increases the risk of contracting the disease more than twice), smoking, exposure to certain chemical compounds used in industry (e.g. arsenic, asbestos), diabetes, chronic kidney disease, hypertension, age (mainly people aged 65-70).
Kidney cancer is not a homogeneous disease. These are six different types of cancer, the dominant of which is renal cell carcinoma, responsible for 80-85 percent. all illnesses. They are characterized by the uncontrolled growth of neoplastic cells within the kidney or adjacent tissues.
Despite the enormous progress in diagnostics and therapy, in many patients, kidney cancer is diagnosed only at an advanced stage, when they already have distant metastases to other organs. One third of patients are affected by the most common carcinoma, renal cell carcinoma. This is mainly because it is usually asymptomatic at first. Over time, you experience haematuria (the most common symptom), back pain below the ribs, palpable lump in the abdomen, chronic fatigue, loss of appetite, weight loss, swollen ankles or legs, recurrent fever. Over 50 percent renal cell carcinoma tumors are detected accidentally during ultrasound or computed tomography of the abdominal cavity for a completely different reason.
The basic method of treatment is surgical removal of the diseased kidney or part of it. However, surgical treatment is fully effective only in patients without metastases. Systemic treatment is required in the disseminated form of the disease.
In the 90s, doctors only had cytokines at their disposal – interferon alpha used in Europe and interleukin 2 used in the United States. Both drugs were not very effective, but their toxicity was significant.
The breakthrough in the treatment of kidney cancer came only 5 years ago, when the European Medicines Agency (EMA) approved sorafenib and sunitinib, drugs with a completely new mechanism of action. Their purpose was not to destroy cancer cells, which is the domain of classic chemotherapy, but to “starve” a tumor by inhibiting the development of blood vessels that nourish it. In the following years, the arsenal of these modern drugs, called angiogenesis inhibitors, was enriched with another four preparations: temsirolimus, everolimus, bevacizumab (administered in combination with interferon alpha) and pazopanib.
– Thanks to these drugs, the survival time of patients is even three to four times longer than that of untreated patients. The quality of their lives is also improving – explains Dr. Piotr Wysocki from the Department of Chemotherapy of the Greater Poland Cancer Center and the Department of Medical Biotechnology at the Medical University of Poznań.
The problem in Poland is the limited access to these drugs. Only one – sunitinib – is reimbursed under the therapeutic program launched by the National Health Fund. If the patient becomes unresponsive to him, the doctor cannot offer him any other therapeutic option.
– Each patient is different, each cancer requires an individual approach to save life or improve its quality during the course of the disease. One drug does not solve the problem. The greater the choice, the greater the range of options, the greater the chances of the patient, and the doctor is sure that he has chosen the best solution – says Prof. Cezary Szczylik.
Clinical trials are the hope for patients. However, not everyone has a chance to participate in them. The study inclusion criteria are very strict. Usually, only young people, without metastases to the central nervous system, not suffering from cardiovascular diseases, qualify for them. Older patients with uncontrolled hypertension and cardiovascular disorders do not stand a chance.
– On the one hand, clinical trials should not be a solution to the economic problems of treatment. On the other hand, the inclusion criteria, due to their restrictiveness and limiting the number of patients, may be a solution only for a very small group of patients, as they only cover selected groups of patients, emphasizes Dr. Piotr Tomczak from the Department of Oncology of the Medical University in Poznań.
Text: Mariola Marklowska-Dzierżak