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Kidney cancer, chronicity is increasingly possible

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Kidney cancer, chronicity is increasingly possible

A campaign to give hope to those affected by kidney cancer. It concerns Italy but it was launched from overseas, where the Asco congress ends today and where the innovations that continue to improve treatments are presented every year, even for this neoplasm. And hope comes from the numbers: in five years, in Italy, people alive after being diagnosed with kidney cancer have increased by 15%: they were around 125,000 in 2018 and became 144,400 in 2022. More than half of the patients diagnosed it also heals early. As regards advanced stage disease – which represents a third of new diagnoses plus 25-30% of progressions from early stages – the data tell us that half of the patients are alive at 5 years and, although in a few cases, even here we begin to talk about healing.

Kidney cancer, never lose hope

by Dario Rubino

The campaign to publicize the progress of research

The campaign was launched by the Italian Association of Medical Oncology (AIOM) and the National Association of Kidney Cancer (ANTURE), with the aim of making patients and citizens aware of the important steps forward in research. Thanks to the unconditional support of IPSEN, webinars, social media activities and a dedicated website will be realized. “The significant increase in survival and in the number of patients alive after diagnosis is due to the introduction of innovative targeted therapies and immuno-oncology which, in almost twenty years, have made it possible to successfully combat even cases of disease in the advanced – says Saverio Cinieri, President of AIOM -. Therapeutic innovation has revolutionized clinical practice and restored hope to millions of people around the world. With this campaign we want to improve the level of awareness of patients and citizens on research progress. Without forgetting the role of lifestyles”.

It has in fact been demonstrated – recalls Cinieri – that physical activity practiced consistently is able to reduce the risk of developing the disease by up to 22%. Not only. Even in patients who have already received the diagnosis, movement can improve treatment results by 15%, reducing fatigue, anxiety and depression, with a positive impact on quality of life. “But, in Italy, as many as 31.5% of citizens are sedentary. More effort is needed to make everyone understand the great benefits of physical activity”.

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Advanced renal cell cancer: combination therapy extends survival by almost 4 years

by Irma D’Aria

Kidney cancer

In Italy, in 2022, 12,600 new cases of kidney cancer were estimated. Symptoms are non-specific and may be overlooked or confused with other conditions such as kidney stones. “When present, the most frequent signs are the presence of blood in the urine, dull pain in the side or a palpable mass in the abdominal cavity”, explains Giuseppe Procopio, Director of Genitourinary Medical Oncology and Prostate Program of the National Cancer Institute of Milan . More than half of the diagnoses occur by chance, as a direct consequence of the increasingly widespread use of diagnostic imaging. In Italy, 71% of people affected by the disease are alive 5 years after diagnosis. These results are possible thanks to an integration of pharmacological, systemic or loco-regional treatments. “At one time – continues Procopio – treatments in metastatic disease were very scarce, today we have numerous active drugs available which include targeted and immuno-oncological therapies – Prof. Procopio points out -. This is a huge step forward, which has allowed, in a decade, to quintuple the 5-year survival in the metastatic stage, going from about 10% to almost 50%. A proportion of these patients remain in complete remission, ie in the absence of detectable disease, and can be considered disease free. Furthermore, we are able to monitor the renal cell carcinoma to prevent it from progressing after the first treatment. Once this result was achieved in 70% of cases, today we are around 85-90%. It’s an evolving scenario.”

There is a therapy for every cancer. Cancer is increasingly treatable

by Daniela Minerva

The news from the Asco congress

Research has also made it possible to optimize the use of the combinations and individual drugs available, especially in the first line of treatment. In particular, the introduction of tyrosine kinase inhibitors, following the discovery of the particular propensity of this tumor to induce the formation of new vessels, has profoundly changed the prospects for treatment. “The combination of targeted therapy and immunotherapy is capable of achieving a median overall survival of 49.5 months in advanced kidney cancer. And an analysis presented at the ASCO Congress showed that this combination is able to preserve quality of life. Also, also at the ASCO Congress, two studies in non-clear cell renal cell carcinoma showed promising data for the combination of targeted therapy and immunotherapy even in less common types of kidney tumors, particularly in papillary tumors. At a longer follow up, reaching 4 years, the efficacy of the combination of targeted therapy and immunotherapy in advanced metastatic disease has been demonstrated. The validity of tyrosine kinase inhibitors is also confirmed after failure of a previous therapy that includes an immunotherapeutic molecule, while the continuation of immuno-oncology in patients already treated with these drugs does not add any advantages. Thus a path is outlined that aims at making the disease chronic, which does not leave the scientific community indifferent and on which it is necessary to inform patients”.

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A tool to better care for the elderly. Asco prize to a European

by Silvio Monfardini

Select patients

In short, in kidney cancer there has been a truly epochal change in the therapeutic scenario, as Carmine Pinto, President of FICOG (Federation of Italian Cooperative Oncology Groups) explains: “The word ‘chronicisation’ has become a consolidated reality in this pathology, with a consistent proportion of patients alive at 5 years and also persistent complete responses, and with a good quality of life. This result was also possible thanks to the research conducted in our country. Experiments today are going in two directions. First of all, it is important to select the patients from a clinical and biological point of view, secondly, in the light of the new combinations, the most effective therapeutic sequences must be defined which contemplate efficacy and quality of life together. Also considering the inclusion in the therapeutic strategies of ablative treatments and primarily of surgery, both of the kidney and of the metastases, and radiotherapy, which can have a significant impact on the natural history and treatment of the disease”.

Kidney cancer: alongside patients with information and support

by Irma D’Aria

The figure of the oncological nurse

The active participation of patients and the shared involvement with doctors are essential to obtain the best therapeutic results. “For this we need to encourage an open dialogue between all the actors involved in the treatment process and recognize the value of active patient involvement, known as ‘patients engagement’ – says Tonia Cinquegrana, President of ANTURE – An aspect on which we must concentrate, together to doctors, is the establishment of a reference figure within the oncology team, who can also provide long-term support and after discharge, answering urgent questions from patients, offering emotional support and helping in the management of side effects of treatments. Unfortunately, in many situations in Italy there is not yet a figure like the Oncology Nurse Practitioner, present in other countries. However, we must work to ensure a better quality of life for those coping with this disease by introducing a role such as the cancer nurse that can make a difference by providing care, education and monitoring of patients after discharge, when they are at home to address the challenges associated with the side effects of treatments”.

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Not the specialist, but the multidisciplinary team

Furthermore, the multidisciplinary collaboration between surgeons, urologists, medical oncologists, radiotherapists, anatomopathologists, psycho-oncologists and nuclear doctors must no longer be an option but an obligation, Cinieri reiterates: “Unfortunately, there are still few dedicated multidisciplinary teams in the area, on the model of the Breast Units for breast cancer. From a medicine based on the single specialist – he concludes – we must arrive at the choice of the best therapy through shared discussion and comparison between several professionals”.

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