The findings showed a subset of adults with advanced kidney cancer have slow-growing disease that can be safely managed using active surveillance, sparing them debilitating side effects of aggressive treatments for anywhere from a year to several years. The average time elapsed before patients on active surveillance needed to start chemotherapy was almost 15 months, with their overall average survival being 44.5 months.
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“It’s not for everybody and we don’t claim everyone should be doing it, but it is for a reasonable proportion of patients,” Dr. Rini said. “The best candidates are low-volume, slow-growing disease, and though both are subjective terms, you know it when you see it. A patient with 5- to 8-mm lung nodules growing slowly by a couple of mm over several months doesn’t probably need immediate attention.”
While the study size was small, and Dr. Rini would like to see a larger group of patients or a randomized trial, he doubts that will ever happen because no drug company would fund such a study and it would be difficult to accomplish.
Still, he believes the approach will gain some momentum, especially considering the Taussig Cancer Institute sees nearly 250 metastatic kidney cancer patients per year compared to the handful that most community oncologists see.
“I think people might do it a little bit more now because there is this data that provides them some reassurance. I think that’s reasonable to expect,” he said. “Publication always provides weight. I wouldn’t be surprised if more community oncologists, who don’t have the level of experience and see the number of kidney cancer patients we treat, might be a little more comfortable with this approach.”
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