Expert Dr. Evan Hall discusses treatment options for renal cell carcinoma, including surgery, medication, ablation, and radiation. Dr. Hall explains when a partial or radical nephrectomy may be recommended and how doctors consider the cancer’s stage, tumor characteristics, and a patient’s individual needs when choosing a treatment approach.
Dr. Evan T. Hall, MD, MPhil is a medical oncologist and researcher at the Fred Hutchinson Cancer Center and an Associate Professor at both Fred Hutch and the University of Washington School of Medicine.
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Transcript
Katherine Banwell:
Dr. Hall, what are some of the most common symptoms and treatment side effects patients may experience, and how are they managed?
Dr. Evan Hall:
Yeah, so for that, I’ll focus on the medicine aspects, which are the parts I tend to supervise. So, for kidney cancer, in terms of medications, if it’s a first attempt at treatment, we usually have one of two types of treatment that patients are exposed to. One type is called immunotherapy. That’s an intravenous treatment, where the goal is to get the immune system to recognize and engage the cancer. And for that type of treatment, the side effects really relate to the body’s immune system causing inflammation in normal parts of the body because it’s a little confused.
The treatment generally kind of broadly turns up the immune system, and many times the immune system will attack the cancer, but also the immune system can cause inflammation in all parts of the body. So, the common things we see, fatigue, rash, itching, joint stiffness or joint aches, hormone imbalances, like in the thyroid gland, those are relatively common. They tend not to be too severe, but they’re definitely in that nuisance-annoying category.
And then the challenging thing with immunotherapy is that there’s a smaller fraction of patients who develop more significant side effects that can be more severe if the immune system causes more and more inflammation in a specific part of the body. That list of things that can happen is pretty long, and most of them are thankfully very rare, but in terms of what patients should do to monitor their body, I usually advise them to say that if you notice something that seems amiss to you, something that’s weird or different, that seems to not be going away.
That’s really when I encourage my patients to call our team, so we can understand what’s going on and decide if it could be related to the treatment or what testing we should do to better understand their situation. The other type of treatment besides immunotherapy that many patients experience early in their treatment course is what we call targeted therapy. These are oral therapies in kidney cancer that specifically work on how the cancer recruits a blood supply, and they have very specific side effects that are much easier to predict.
And the most common side effects there are increases in blood pressure, fatigue, some element of nausea, diarrhea is relatively common, an interesting rash that tends to affect mostly the palms of the hands and soles of the feet, and irritation in the mouth. Those are relatively common side effects of that class of drugs. What’s unique about those drugs is they come in different doses.
So, if those side effects are severe, we usually reduce the dose or try to find an alternate formulation of the treatment that might allow patients to have fewer side effects. But in those treatments, it’s a little more of a predictable list of side effects that people may experience.
Katherine Banwell:
Dr. Hall, if a patient is taking medication at home, why is following a treatment plan important?
Dr. Evan Hall:
Yeah, I think it’s quite important when we make a recommendation for treatment, we’re doing that based upon evidence that it’s helped patients similar to the patient we’re treating, and deviations from that, they’re allowed, but I think it’s really important that that’s a shared decision and discussion with the medical team, so there are all sorts of good reasons why taking a break or a holiday or interrupting treatment, reducing the dose, may be appropriate, but that’s really a decision that should be made in conjunction with the guidance of the medical team.
Because there could be potential side effects or issues with withdrawing these treatments or not taking them if you’ve been taking them for a while. For example, blood pressure, some patients have to start a new blood pressure medicine if they’re on one of these pill-based targeted therapies, and if you abruptly discontinue it, patients can actually, but still take the blood pressure medicine.
You can actually have low blood pressure and become dizzy or lightheaded, and that can create its own problems, so I think as a field, oncologists are pretty flexible. If something’s not working in terms of the day-to-day of a certain treatment plan, we want to make adjustments and try to help make it work better or have fewer side effects, but that’s a dialogue and should be done in conjunction with the medical team.