Treatment for metastatic kidney cancer is evolving rapidly, as providers move away from performing upfront cytoreductive surgery and navigate a growing number of new therapies and combined drug regimens. SCCA’s Kidney Cancer Multispecialty Clinic (KCMC) offers multidisciplinary consultations and care to help community oncologists and their patients understand and access the latest treatment options.
Two SCCA kidney cancer experts, John Gore, MD, MS, FACS, Associate Professor, Department of Urology; Adjunct Associate Professor, Department of Surgery, and Scott Tykodi, MD, PhD, Associate Professor, Division of Medical Oncology, recently joined the Oncology Sound Byte podcast to talk about the clinic and how treatment is evolving.
“The clinic was born out of our observation that many kidney cancer patients were having to wait days or even weeks between appointments with different providers,” Dr. Tykodi says. “At the KCMC, patients can see a medical oncologist, a surgeon, a radiation oncologist and even a geneticist and nutritionist, in a single afternoon. This enables each patient to quickly get a comprehensive game plan.”
When is upfront cytoreductive surgery appropriate?
One of the most significant recent changes in care has been the move to start many metastatic kidney cancer patients on systemic therapy before cytoreductive surgery.
“An easy way to think about it is that systemic disease requires systemic therapy,” says Dr. Gore, a clinician, surgeon and researcher. “And if we’re doing surgery first, it imposes a delay on starting what they really need.”
Still, there are nuances in deciding when upfront surgery isn’t needed. For instance, patients with metastatic disease who also have hematuria, inferior vena cava thrombosis and/or significant pain may benefit from upfront cytoreduction.
“This is one reason why care from an experienced, multidisciplinary team is important,” Dr. Tykodi says. “Our physicians can consult with each other, discuss the different options and work together to match each patient with the treatment that’s right for them.”
Selecting the right drug regimen
When a patient does avoid cytoreductive surgery, multidisciplinary expertise is also useful in helping select the appropriate drug regimen. There are currently multiple two-drug regimens in use, and three- and even four-drug combinations are becoming options.
With the drug landscape changing quickly, it isn’t always clear which regimen is best. SCCA providers’ experience with a wide variety of patients and the latest investigational regimens helps determine the optimal fit.
Expanded geographic reach
SCCA is the region’s largest kidney cancer referral center. We see patients throughout the Washington-Alaska-Montana-Idaho-Oregon-Hawaii region and regularly work with primary care teams to help them determine which standard therapies and clinical trials are available.
“Telehealth has enabled more patients to get specialized consultation from us at a distance, with the expectation that they’re likely to stay in their local care network and move ahead with the game plan with their local providers,” says Dr. Tykodi.
The telehealth team at SCCA is pursuing options to continue providing telehealth services through permanent licensure of SCCA providers outside of Washington state.
