To be eligible for this trial, the cancerous kidney had to be removed and its tumor processed for genetic material within 30 minutes. It was felt that the major blood vessels could not be reconstructed within 30 minutes using a robotic approach and that an open approach was too invasive for this patient.

So time was a critical issue in this surgical approach and it required interventional radiology, surgery, pathology, and medical oncology. The patient was released from the hospital within 48 hours of the AngioVac procedure and went on to have a robotic nephrectomy the following week, again released from the hospital within 48 hours.


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“There was a lot of discussion about this before we got started. There was concern about part of tumor breaking off and spreading to the lungs,” explained Dr. Rogers.

“However, this patient already had spread of cancer to his lungs, which is why we considered him for the procedure. The procedure was a success and is now an exciting proof of principal that hopefully can be extended to other patients. It begins a whole new paradigm in treating patients with locally advanced and metastatic kidney cancer. The next step for the AngioVac would be treating advanced kidney cancer that grows all the way to the heart, which traditionally requires opening the chest and using a heart bypass machine to remove the tumor. We are hoping that in those patients we can suck the tumor out and not involve all the vascular risks to the patient.”

He said this technique had the potential to significantly lower morbidity in this patient population because the incisions are significantly smaller and there is no need to open the chest to put the patient on a bypass machine.

Kidney cancer is now the sixth most common cancer in the United States and it is estimated that in 2015 there will be an estimated 63,920 adults (39,140 men and 24,780 women) diagnosed with kidney cancer and renal pelvic cancer.2

The overall 5-year survival rate is pegged at 72%, but those percentages drop dramatically in patients with metastatic disease.

President of International Society of Neurovascular Disease (ISNVD) Ziv Haskal, MD, who is a professor of radiology at University of Virginia School of Medicine in Charlottesville, VA, told Cancer Therapy Advisor that this is “an exotic” and promising approach for patients with metastatic kidney cancer.

He said this combination vacuum technique may help meet a large unmet clinical need. “It does suggest an intriguing new use for the AngioVac, which is kind of a big buzz right now,” said Dr. Haskal.

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Sandeep Bagla, MD, who is an interventional radiologist at Inova Alexandria Hospital in Alexandria, VA, said collaborations between interventional radiologists and the oncology team are transforming the care of kidney cancer. 

He said gradual changes in the medical management of the disease over the past 10 years along with improved interventional techniques are leading to novel treatments.

“The technology has improved so that we can now treat larger tumors and it is now being offered more at numerous centers around the country. The difference now is that the interventional radiologists gets involved early so the patient doesn’t go off and get treatment in one area and does not get the benefit of minimally invasively treatment,” said Dr. Bagla.

He said this approach has the potential to significantly lower kidney cancer mortality rates. At the same time, it may be able to lead to shorter hospital stays and lower overall health care costs. “It is really interesting on multiple levels,” said Dr. Bagla in an interview with Cancer Therapy Advisor.

“My message is to oncologists is that when you are dealing with any cancer patient it is critical to get the interventional radiologist involved early because they often have many minimally invasive options that may not be known to the oncologists.”

References

  1. About AGS-003. Argos Therapeutics. http://adaptkidneycancer.com/about-ags-003/. Accessed March, 13, 2015.
  2. Kidney Cancer: Statistics. Cancer.Net. http://www.cancer.net//cancer-types/kidney-cancer/statistics. Published June 2014. Accessed March 13, 2015.