It may now be possible to extend the benefits of minimally invasive surgery to some patients diagnosed with highly complex, advanced kidney cancer.
Physicians at Henry Ford Hospital in Detroit, MI, have successfully suctioned a cancerous tumor from a major vein in a 60 year old patient with metastatic kidney cancer, clearing the way for him to undergo a minimally invasive kidney removal.
This approach also helped the patient to be eligible to participate in a clinical trial using genetic material from his tumor to produce a vaccine to help fight his metastatic disease.
The team performed a robotic-assisted laparoscopic radical nephrectomy using an AngioVac, which employs large suction catheters to filter blood through a cardiac bypass machine.
Currently, it is used to remove clots, tumors or other foreign material. In growing numbers interventional radiologists are working more closely and collaboratively with oncology teams. These new collaborations are ushering in new approaches to treating metastatic kidney cancer.
“At our institution we have a very close relationship with our interventional radiologists. We send patients back and forth all the time. This is just in that same vein of collaboration,” said urologic surgeon Craig Rogers, MD, who worked with interventional radiologist Scott Schwartz, MD, and a multidisciplinary team in pioneering this approach.
“We have used a robotic approach in the past in patients with advanced kidney cancer growing into the major vein that extends towards the heart. But there was a lot of holding your breath when opening the major blood vessels and reconstructing them robotically, hoping it works well without any major bleeding. Our new approach suctioned the tumor out of the vein, making the robotic nephrectomy much easier and safer.”
There are approximately 60,000 new cases of kidney cancer diagnosed each year in the United States and about a third of the cases involve metastatic disease. Historically there have been limited treatment options.
“Many patients are showing up with metastatic disease and have no definitive cure. We can help the patients with smaller tumors, but we aren’t much farther along than we were decades ago in patients with metastatic disease in offering curative treatments,” Dr. Rogers said in an interview with Cancer Therapy Advisor.
“The AngioVac potentially offers patients with metastatic kidney cancer involving major blood vessels a less invasive and less risky option to have the tumor removed, allowing them to recover more quickly with a better quality of life and proceed to medical treatments.”
Dr. Rogers said his patient had a tumor that had spread into his vena cava and his lungs. Traditionally, he said that would have required a complex surgery to remove the cancerous kidney and the cancer extending into the vena cava. Surgeons would need to clean out the large vein and reconstruct it back together.
Using this approach also allowed the patient to participate in a clinical trial, in which RNA was taken from a patient’s kidney tumor to create a vaccine.1
Patients in this trial with metastatic kidney cancer are assigned to receive standard treatment (sunitinib) with or without AGS-003. They undergo a standard leukapheresis procedure to capture the white blood cells needed to create AGS-003. The patients then start the first 6-week course of sunitinib prior to receiving their first dose of AGS-003.