What Treatments Are Available?


Click on the link and it will take you to the treatment;

Surgery

People may want to ask the Doctor these questions before having surgery

Laparoscopic Kidney Cryoablation / Radiofrequency Ablation

Cytoreductive (debulking) nephrectomy

Arterial embolization

People may want to ask the doctor these questions before having arterial embolization

Immunotherapy (cytokine-based therapies)

RENAL CELL CARCINOMA TREATMENT REGIMENS

Molecular Targeted Therapies ( V.E.G.F.) angiogenesis and (mTOR inhibitors)

Chemotherapy

Radiation therapy

Sirtex/SIR-Spheres

Frequently used terminology A B C D E F G H I J K L M N O P Q R S T U V W Z


There are different types of treatment for patients with renal cell cancer.Different types of treatments are available for patients with renal cell cancer. Some treatments are standard (the currently used treatment) and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Surgery

Renal cell carcinoma resection is the best treatment for RCC that has not spread (stage I, II and III disease) and will often place the majority of people whose cancer falls into this category into remission. The extent of surgery depends on the size and location of the tumour.

Surgical options include

In stage I or II RCC the standard management is radical nephrectomy. RCC in both kidneys occurs more commonly in people who have inherited conditions such as von Hippel-Lindau disease, tuberous sclerosis and papillary RCC. Surgery in this instance aims to spare as much kidney tissue as possible, followed by close monitoring for development of further RCCs. Rarely, radical nephrectomy in addition to surgery to remove metastases may be considered in selected people who have a removable primary tumour in the kidney, in addition to a single metastasis elsewhere. Close monitoring following surgical removal is important to allow early diagnosis if the cancer returns.

For some people, surgery may not be appropriate, such as those who cannot tolerate anaesthetic, the very elderly and those with other severe medical conditions. Most small tumours, previously all thought to be benign, grow slowly, cause no symptoms and don't spread. Around 40% of tumours smaller than 1cm are found to be benign. For this reason, conservative management (i.e. no surgery) with regular monitoring ("watchful waiting") may be the most appropriate treatment option for these patients.

For people with advanced or metastatic disease, curative surgery is usually thought not possible. In these cases a number of different therapies have been trialled. Recent studies have improved the understanding of how RCC occurs, and have led to development of specific treatments that are targeted to treat the disease process. These specific treatments have shown selective benefit in previously untreatable metastatic kidney cancer.

Nephrectomy is major surgery. For a few days after the operation, most patients need medicine to relieve pain. Discomfort may make it difficult to breathe deeply and patients have to do special coughing and breathing exercises to keep their lungs clear. Patients may need IV (intravenous) feedings and fluids for several days before and after the operation. Nurses will keep track of the amount of fluid the patient takes in and the amount of urine produced. The remaining kidney takes over the work of the one that was removed.

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People may want to ask the doctor these questions before having surgery

Laparoscopic Kidney Cryoablation / Radiofrequency Ablation

Definition:
Laparoscopic kidney cryoablation or radiofrequency ablation represents a combination of two minimally invasive surgical technologies that can be used to treat kidney cancer. Laparoscopy refers to the use of small incisions through which a small camera and instruments can be placed into the body. This technique helps avoid the larger cut that is associated with traditional “open” surgery. During laparoscopic cryoablation for kidney cancer, the surgeon uses this laparoscopic technique to perform exactly the same maneuvers that an open surgeon would perform. The kidney is exposed and treated.
Link:- Web site

Cytoreductive (debulking) Nephrectomy

Cytoreductive nephrectomy involves removal of most of the primary tumour from the kidney. People with advanced RCC who undergo cytoreductive nephrectomy before treatment with IFNa immunotherapy, have improved survival compared with those whose primary kidney tumours are not removed.

Pre-operative biopsy may be used in individuals being considered for cytoreductive nephrectomy, in order to confirm that the tumour is clear cell carcinoma (the only subtype for which IFNa has been proven to work).

The role of cytoreductive nephrectomy in people who will receive molecularly targeted therapy remains unclear. The role of surgery with IFNa therapy may change in the future as molecularly targeted therapies improve.

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Arterial Embolization

When surgery to remove the cancer is not possible, a treatment called arterial embolization may be used to shrink the tumour. A small incision is made and a catheter (thin tube) is inserted into the main blood vessel that flows to the kidney. Small pieces of a special gelatin sponge are injected through the catheter into the blood vessel. The sponges block the blood flow to the kidney and prevent the cancer cells from getting oxygen and other substances they need to grow. Embolization can cause pain, fever, nausea, or vomiting. These problems are treated with medicine. Often, patients also require intravenous fluids.

People may want to ask the doctor these questions before having arterial embolization

Non-surgical treatments

Immunotherapy

A medication called Interlukin-2 (Aldesleukin, Proleukin or IL-2) given at high doses can sometimes be an effective treatment for RCC by activating the body's immune system to fight the RCC. Suppression of the cancer may last years and those who respond completely (approximately 10% of people) tend to remain well long term. However, IL-2 has significant side effects. You cannot have any vaccinations while you are having aldesleukin, or for 3 months after you have finished your treatment. You should tell your doctor if you have;

Immunotherapy for individuals whose cancer has returned following surgery is most effective for those who have a high level of function. People with a good performance status are able to move around and carry out fairly normal daily activities. People with poor performance status are confined to bed or a chair for most of the day. Immunotherapy was previously very widely used to treat RCC. Now, it is mainly used to treat people who have a good performance status and have other factors that indicate their cancer will respond well to treatment.

Other forms of immunotherapy (e.g. Interferon, low dose IL-2) have been replaced by molecularly targeted agents.

Those with non-clear cell RCC do not appear to respond to immunotherapy, though research related to this is limited.



IFN-alfa and IL-2 :- Interlukin-2 (Aldesleukin, Proleukin or IL-2) have continued to be considered active and usable therapies in RCC. The historic use of these agents and the observation of long-term complete remissions following treatment in a small number of patients have kept them in the armamentarium for RCC. The toxicity of these immunotherapies has made them less desirable than VEGF- and mTOR-targeted therapies. However, RCC is still considered an immunologically active disease in which immunotherapy holds promise. Thus, a number of noncytokine strategies have been and are being explored.

IMA901:
IMA901 is a therapeutic cancer vaccine that consists of synthetic RCC tumor-associated peptides and that has been shown to cause T-cell activation. In a phase I study, 30 patients with stage III or IV RCC were each given 8 intradermal IMA901 vaccinations over 64 days. In this study, T-cell responses were measured in peripheral blood using IFN ELISPOT, human leukocyte antigen (HLA) multimer analysis, and CD4+ Foxp3+ regulatory T-cell levels. One patient had a PR and seven had SD; patients in whom multiple T-cell responses were elicited had better clinical outcomes.[32,33]
A randomized phase II study evaluated IMA901 (17 intradermal vaccinations over 9 months) with or without a single dose of cyclophosphamide(Drug information on cyclophosphamide) (300 mg/m2) administered prior to the first vaccination in patients with cytokine- or TKI-refractory RCC.[34] After 6 months, the disease control rate was 31% in cytokine-refractory patients and 12% in TKI-refractory patients. While the impact of pretreatment cyclophosphamide was not reported at the initial presentation of the trial data, pretreatment cyclosphosphamide did appear to trend toward better overall survival. In patients who had received previous cytokine therapy, the OS rate at 18 months was 83% in those who received pretreatment cyclophosphamide vs 68% in those who did not receive this pretreatment.
IMPRINT is an ongoing phase III trial of IMA901 in combination with sunitinib for first-line treatment of RCC. Approximately 330 patients will be randomly assigned to receive IMA901 either with or without sunitinib. The primary endpoint of this study is overall survival, with secondary endpoints including PFS, safety and tolerability, and cellular immunomonitoring to assess T-cell response to IMA901.

AGS-003:
AGS-003 is an autologous cell-based therapy in which mature dendritic cells are collected and electroporated with CD40L and autologous amplified tumor RNA. A phase II study of AGS-003 with sunitinib in newly diagnosed RCC was completed. The combination was well tolerated with no grade = 3 treatment-related adverse events reported. Of 21 patients at poor or intermediate risk, 2 experienced a PR and 11 had SD; median PFS in this population was 12.5 months. This effect correlated with a decrease in the percentage of T-regulatory cells and a concurrent expansion of CD28+ effector memory cytotoxic T-lymphocytes, which may have been responsible for the overcoming of tumor-induced immunosuppression. The magnitude of this immunologically mediated clinical effect parallels the PFS seen with sunitinib alone and is likely to be biologically unrelated. Thus, a phase III randomized, blinded study is planned that will compare sunitinib alone vs sunitinib with AGS-003 in newly diagnosed patients.

Anti-CTLA-4 antigen: ipilimumab (Yervoy) :
CTLA-4 (CD52) is an inducible receptor expressed by T cells that ligates the B7 family of molecules (primarily CD80 and CD86) on antigen-presenting cells. It serves as a natural inhibitor of T-cell activation and is overexpressed on cancer cells, including RCC cells. Suppression of this immune repressor was hypothesized to decrease a cancer’s ability to avoid immune surveillance.
Ipilimumab is a monoclonal antibody against CTLA-4 that has been tested in a number of cancers, including RCC. In a phase II RCC study, tumor regression was noted. However, this phenomenon was associated with major gastrointestinal and endocrine toxicities that have been attributed to iplimumab. Its also a
Immune Checkpoint
Researchers have begun to look at ways in which we might be able to reinstate the immune response with targeted agents, essentially indirectly treating cancer by treating the immune system. One particularly promising strategy for doing this is to target so-called immune checkpoints, which act as the off-switch on the T cells of the immune system.


PD-1 antibody: Nivolumab (Opdivo) BMS-936558 (MDX-1106, ONO-4538) :
B7 homolog 1 (B7-H1) is a factor that participates in T-cell costimulation, functioning as a negative regulator of immunity. It is expressed by aggressive RCC, displaying prognostic importance. B7-H1 impairs host immunity by interaction with the Programmed Death-1 receptor (PD-1). PD-1 is expressed on activated T cells, and like B7-H1, it is also upregulated in high-risk RCC. It is thought that this interaction may contribute to immune dysfunction in patients with RCC.
Lenvatinib is a receptor tyrosine kinase inhibitor that inhibits the kinase activities of the vascular epithelial growth factor (VEGF) receptors VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4). Lenvatinib also inhibits other receptor tyrosine kinases implicated in pathogenic angiogenesis, tumor growth, and cancer progression in addition to their normal cellular functions, including the fibroblast growth factor (FGF) receptors FGFR1, 2, 3, and 4; platelet-derived growth factor receptor alpha (PDGFRa); KIT; and RET.
Lenvatinib carries warnings/precautions for hypertension, cardiac failure, arterial thrombotic events, hepatotoxicity, proteinuria, diarrhea, renal failure and impairment, gastrointestinal perforation and fistula formation, QT interval prolongation, hypocalcemia, reversible posterior leukoencephalopathy syndrome, hemorrhagic events, impairment of thyroid-stimulating hormone (TSH) suppression/thyroid dysfunction, and embryofetal toxicity. Patients should be monitored for blood pressure, clinical signs/symptoms of cardiac decompensation, liver function, proteinuria, electrolyte imbalance, blood calcium levels, and TSH. ¦
BMS-936558 is a fully human monoclonal antibody to PD-1. In a phase I dose-escalation study of 39 patients with advanced refractory solid tumors, BMS-936558 showed antitumor activity, including a PR in 1 patient with RCC.[45] In a second phase I study, 126 patients, including 18 with RCC, were treated with escalating doses of BMS-936558.[46] Of 16 patients with RCC who received a 10-mg/kg dose of BMS-936558, 5 achieved an objective response, with 1 CR; 6 had SD for > 4 months. The most common adverse events attributed to this agent include depressed CD4+ counts (36%), lymphopenia (26%), fatigue (15%), and musculoskeletal events (15%).
An ongoing, randomized, blinded phase II study is evaluating three doses of BMS-936558 in patients with RCC who have received prior antiangiogenic therapy. The estimated study completion date is April 2013.

Pembrolizumab, (formerly MK-3475 and lambrolizumab, trade name Keytruda) :
Anti–PD-1 Immunotherapy. KEYTRUDA is a programmed death receptor-1 (PD-1)-blocking antibody
Pembrolizumab is a therapeutic antibody that blocks the inhibitory ligand of programmed cell death 1 receptor located on lymphocytes. This receptor is responsible for inhibiting the immune response to cancer cells which express programmed death-ligand (PD-L1 or PD-L2). Normally, this effect is necessary to avoid inappropriate overreaction, such as an auto-immune disease, in healthy individuals.[9] In cancer patients antibody blockade against this receptor such as with Pembrolizumab reinvigorates the immune system, allowing it to target and destroy cancer cells.[10] Pembrolizumab is one of a number of closely related therapies dubbed checkpoint therapy.

Utomilumab (PF-05082566) :
Targets this antibody to stimulate a more intense immune system attack on cancers. It is a fully human IgG2 monoclonal antibody. It is in early clinical trials. As of June 2016 5 clinical trials are active.

Renal Cell Carcinoma Treatment Regimens

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Molecular Targeted Therapies

Development of agents which target the specific biological pathways that cause RCC, have been the main development in the treatment of RCC in recent years.

Sutent - (Sunitinib) is a VEGF (vascular endothelial growth factor) receptor inhibitor and works by blocking the pathway that allows blood vessels to supply the cancer as it is growing. It is an effective first line therapy for advanced clear cell carcinoma, which is the most common type of RCC.

Nexavar - (Sorafenib) and Avastin - (Bevacizumab) are other similar forms of therapy that may be used as initial treatment in people with advanced RCC, or those who have failed cytokine therapy.

Torisel - (Temsirolimus) is another drug which works on a different pathway and may be used as initial treatment for people with advanced RCC. It significantly increases survival and is a good alternative to VEGF pathway inhibition, particularly in people with a poor prognosis.

Afinitor - (Everolimus) is a once-daily, oral inhibitor of mTOR (mammalian target of rapamycin) indicated for the treatment of patients with advanced renal cell carcinoma after failure of treatment with Sutent or Nexavar. The active ingredient in Afinitor, Everolimus, specifically blocks the activity of mTOR, an intracellular regulator important in tumour progression. Unlike other therapies that primarily inhibit tumour angiogenesis, Afinitor targets both tumour cells and blood vessel cells. Afinitor specifically blocks mTOR in 2 places, resulting in 3 distinct effects:

Votrient - (Pazopanib)Votrient, is a once-daily, oral medication. It is an angiogenesis inhibitor which may help prevent the growth of new blood vessels, thereby blocking the growth of kidney cancer tumors that need blood vessels to survive.

Axitinib - Axitinib is an indazole derivative that is a highly effective inhibitor of the family of VEGF receptors (VEGFR-1, -2, and -3), and of platelet-derived growth factor receptor (PDGFR)-beta and c-Kit.[5] It has demonstrated activity following sorafenib and cytokine therapy.[6] Given emerging trends in RCC therapy, an international phase III study (AXIS) was initiated for patients with disease refractory to sunitinib, bevacizumab with IFN-alfa, temsirolimus, or other cytokine-based therapies. In the AXIS study, 723 patients were randomly assigned to receive axitinib (n = 361) or sorafenib (n = 362). Treatment with axitinib was associated with a progression-free survival (PFS) of 6.7 months, compared with 4.7 months for sorafenib (hazard ratio [HR], 0.665; P < .0001).[7] These data were presented and reviewed favorably at an FDA advisory board meeting in December 2011.

Tivozanib (AV-951, KRN-951) - Like axitinib, tivozanib is another orally available, ATP-competitive, small molecule inhibitor of VEGFR-1, -2, and -3, with inhibition in the picomolar range. In the nanomolar range, tivozanib inhibits phosphorylation of c-Kit and PDGFR-beta but has limited activity against other type III receptor tyrosine kinases (RTKs).[8] A randomized discontinuation trial of tivozanib was conducted that included clear-cell and non–clear-cell RCC.[9] Median PFS was 12.5 months for patients with clear-cell carcinoma. At the initial report of this study, median PFS had not been reached for patients with papillary RCC; median PFS for patients with other subtypes was 5.4 months. The overall response rate (ORR; complete response [CR] + partial response [PR]) and stable disease (SD) rate were 29% and 56%, respectively, for patients with clear-cell RCC; 18% and 82% for patients with papillary RCC; and 17% and 57% for patients with other non-clear subtypes. For patients with clear-cell RCC, median PFS was 14.8 months. The phase III study (TIVO-1) in which tivozanib was compared with sorafenib in patients who had not been exposed to STIs has been completed; the results are pending. As with sunitinib, hypothyroidism has been reported as an adverse event related to this drug.

Cediranib (AZD2171) - Cediranib is a third pan-VEGFR inhibitor that has shown promising activity. In a preliminary report of a single-arm phase II study of cediranib in treatment-naive RCC, 12 of 32 evaluable patients (38%) had a PR, and 15 patients (47%) had SD, yielding a benefit rate of 85%.[10] In a randomized, double-blind, phase II trial in the United Kingdom (UK), 71 patients with RCC were randomized 3:1 to cediranib or placebo.[11] At 12 weeks, the investigators noted a highly significant difference in mean percentage change in tumor size between the study and control groups (-20% vs +19%, P < .0001). Of the 18 patients in the placebo arm, 14 crossed over to cediranib; of these 14 patients, 10 had tumor reduction. In the cediranib arm, 34% achieved a PR, and 47% had SD. Adverse events were typical for VEGFR inhibitor therapy, but 87% of patients required a dose reduction or pause at a median time of 29 days because of toxicities, including diarrhea (88%; 13% grade 3 or higher) and hypertension (61%; 19% grade 3 or higher). Given the level of availability of targeted agents in the UK at the time this study was designed and initiated, the use of a placebo arm was still considered acceptable. With a number of approved treatments now available globally, it is improbable that future randomized studies in metastatic RCC will include placebo arms, due to ethical concerns.

Tecentriq (Atezolizumab also known as MPDL3280A, ) - Atezolizumab blocks the interaction of PD-L1 with programmed cell death protein 1 (PD-1) and CD80 (B7-1). PD-L1 can be highly expressed on certain tumours, which is thought to lead to reduced activation of immune cells (cytotoxic T-cells in particular) that might otherwise recognize and attack the cancer. Inhibition of PD-L1 by atezolizumab can remove this inhibitor effect and thereby engender an anti-tumour response. It is one of several ways to block inhibitory signals related to T-cell activation, a more general strategy known as "immune checkpoint inhibition."
For some cancers (notably bladder) the probability of benefit is related to PD-L1 expression, but most cancers with PD-L1 expression still do not respond, and many (about 15%) without PD-L1 expression do respond.

Non-TKI VEGF Inhibitors:

Aflibercept (VEGF Trap, AVE 005) - Aflibercept is a soluble decoy receptor incorporating domains of both VEGFR-1 and -2 fused to the Fc region of human IgG1. Thus, aflibercept binds all isoforms of VEGF-A and placental growth factor (PlGF) with high affinity.[12] Aflibercept has completed phase I testing and has moved to phase II testing in RCC.[13,14] The randomized phase II study tests two doses of aflibercept and is expected to complete accrual by 2016.

Ramucirumab (IMC112B) - Ramucirumab is a fully human, high-affinity monoclonal antibody to the extracellular domain of VEGFR-2.[15] Its binding prevents ligand binding. A phase II trial evaluating ramucirumab in TKI-refractory RCC completed accrual in 2011. The final report on this important study is not yet available.

Fibroblast Growth Factor Receptor Inhibitors: The family of fibroblast growth factor receptors (FGFRs) is known to be overexpressed in RCC.[16] Activating mutations of FGFRs and their ligands have been associated with neoplastic progression and tumor vascularization in RCC. This pathway is believed to potently inactivate angiogenesis in the stromal compartment parallel to VEGFR inhibition, while also directly antagonizing FGFR-driven proliferation in tumor cells.

Dovitinib (TKI1258, CHIR-258) - Dovitinib is an orally bioavailable inhibitor of FGFR-1,-2, and -3; VEGFR-1, -2, -3; and PDGFR-beta.[17] A phase II study has been completed in patients with unresectable or metastatic RCC who have received previous VEGFR-TKI therapy. In a preliminary report, 8% of evaluable patients experienced a PR and 8% had SD for 4 months or more, yielding a benefit rate of 16% in the second-line setting. Median PFS and overall survival (OS) were 6.1 months and 16 months, respectively.[18] There is currently a phase III study of dovitinib vs sorafenib(Drug information on sorafenib) underway for patients who have been treated with both a VEGF-targeted agent and an mTOR inhibitor. This study is expected to complete accrual in May 2013.

BIBF 1120 - is an inhibitor of VEGFRs, PDGFRs, and FGFRs.[19] Of 10 RCC patients in a phase I study of BIBF 1120, 1 patient had a CR, 1 had PR and the majority of the remaining 8 patients had SD.[20] An ongoing phase II study comparing BIBF 1120 with sunitinib in the first-line setting for RCC was recently completed. Results are eagerly anticipated.

Lenvatinib (E7080) - Lenvatinib is another orally bioavailable inhibitor of multiple receptor tyrosine kinases, including VEGFRs, PDGFR-beta, FGFR-1, and c-Kit. [21] This agent is still in early development and has completed phase I testing in advanced solid tumors to determine dosing. In this phase I dose-escalation study of 27 patients, common adverse events were hematuria, fatigue, hypertension, increased transaminase levels, headache, proteinuria, diarrhea, and increased lactate dehydrogenase.[22] Of the 25 evaluable patients, there was 1 PR in a patient with colon cancer, and 21 patients with SD. The patient with a PR achieved this reduction at cycle 4 and continued for a total of 10 cycles, at which time progression of disease was noted. An ongoing phase I/II study with a randomized phase II portion is evaluating lenvatinib alone or in combination with everolimus in patients with RCC who are refractory to VEGF-targeted treatment. Accrual should be complete by September 2013.

Regorafenib (BAY 73-4506) - Regorafenib is another orally bioavailable TKI with activity against multiple proangiogenic signals, including the FGFR, VEGFR, and PDGFR families, as well as c-Kit, RET, and B-RAF. A phase II trial of regorafenib for therapy-naive RCC has been completed. In a preliminary report on 33 evaluable patients, 27% experienced a PR and 42% had SD, for a benefit rate of 69%. Common treatment-related adverse events for all enrolled patients were hand-foot skin syndrome, fatigue, mucositis, hypertension, rash, alopecia, diarrhea, dysphonia, and anorexia.

Angiopoietin-TIE2 Inhibitor: While VEGF and the VEGFR family of receptors are strongly associated with angiogenesis, there remain a number of additional signaling pathways that may drive this process and that are amenable to pharmacologic intervention; these include the angiopoietin-TIE2 axis. Ang-1, Ang-2, and Ang-4 are the known ligands for the TIE2 receptor expressed on vascular endothelial cells. AMG386 is a neutralizing peptibody targeted against Ang-1/2 that prevents interaction with the TIE2 receptor.

AMG386 (2xCon4[C]) - n a phase I study, AMG386 demonstrated antitumor efficacy, with treatment-related adverse events of fatigue and peripheral edema. Of the 29 evaluable patients, there was 1 who experienced a PR and 16 patients with SD. The PR was noted at week 68 in a patient with refractory ovarian cancer. After 156 weeks of treatment, she withdrew from the study with a continued PR. Unlike with VEGF-targeted therapies, the incidence of hypertension with AMG386 was low and not considered treatment-related. A phase Ib study evaluated AMG386 combined with sunitinib or sorafenib in patients with RCC.An interim analysis showed 1 CR, 7 PRs and 6 patients with SD among those receiving AMG386/sunitinib (n = 15); and 5 PRs and 9 patients with SD among those receiving AMG386/sorafenib (n = 17). While both sunitinib and sorafenib have demonstrated clinical benefit for patients with RCC, these phase I data suggested the possibility of a more potent antitumor effect gained from the addition of AMG386 (as compared to monotherapy with the VEGFR STIs) without substantial increase in harm. Given the high level of activity and acceptable toxicity, the combination was pursued in more advanced testing.
In a phase II trial, 152 treatment-naive patients were randomized 1:1:1 to receive sorafenib combined with AMG386 (10 or 3 mg/kg) or placebo once weekly; ORR was 38%, 37% and 24%, respectively, although PFS was similar for all three arms.[27]. This response rate can be compared with the 10% PR rate observed in the phase III study of sorafenib in RCC. After making this comparison, it appears that despite the recognized activity of sorafenib, the addition of AMG386 does appear to augment its antitumor effect. Thus, a combination such as this may be worth additional study. An ongoing phase II trial is evaluating AMG386 combined with sunitinib as first-line therapy in metastatic RCC (mRCC), or for cytokine-refractory mRCC; the expected completion date is sometime in 2014.

AKT Inhibitors:

MK-2206 - AKT has long been viewed as a convergence point for multiple oncogenic and pro-angiogenic signals. To date, few effective inhibitors of AKT have been developed, mainly because of excessive clinical toxicity. MK-2206 is a novel targeted small molecule that is a putative allosteric inhibitor of AKT activation.[28] A randomized phase II study comparing MK-2206 vs everolimus as second-line therapy following VEGF-targeted therapy is now underway. Dose-limiting toxicities of this agent included skin rash, nausea, pruritus, hyperglycemia, and diarrhea.

MET Inhibitor:

Foretinib (GSK136089, GSK089, XL880) - MET overexpression has been implicated as a pro-oncogenic and tumor survival mechanism in a number of tumor models, including RCC—and especially in non–clear-cell carcinomas, including chromophobe and papillary RCCs.[29] A MET mutation in RCC is considered rare outside of lung carcinomas and papillary RCC.[30] Foretinib is an orally available inhibitor of MET and the VEGFR family. A trial in patients with papillary RCC has been completed, and results are currently pending. Patients in this study were stratified based on the status of MET pathway activation (activation MET mutation, MET [7q31] amplification, or trisomy 7). In a preliminary report of this study, of 35 evaluable patients, there were 4 who experienced confirmed PRs and 27 patients with SD.[31] In addition to MET status, the investigators will report on the utility of shed MET, VEGF, and shed VEGFR2 as pharmacodynamic markers of foretinib activity.

 

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Chemotherapy

Why is Clear cell RCC resistant to chemotherapy? Because RCC is slow-growing. When RCC becomes aggressive and grows fast, it becomes susceptible to
chemotherapy. Traditional chemotherapy goes after the cells that are dividing fastest, which is why chemo causes hair loss and sores in the mouth and throat.
(Hair cells and the lining of the digestive system are two types of cells that normally divide very quickly to grow or to replace themselves.)

Some non-clear cell carcinomas may respond to chemotherapy in a minority of cases. Combinations of platinum agents, ifosfamid, gemcitabine and taxanes tend to be used. They may be effective for treating collecting duct tumours, sarcomatoid RCCs and renal medullary carcinoma (which may also respond to Bortezomib).

People with papillary (chromophilic) RCC do not tend to respond to chemotherapy.

Chemotherapy or molecularly targeted agents are the preferred first treatment for individuals with advanced RCC found to be non-clear cell carcinoma.

Radiation Therapy

Most renal cell carcinomas are radiation resistant. However, radiation therapy may be useful for painful bony metastases, brain metastases and painful recurrences of tumour in the renal bed (where the kidney usually sits).

Radiotherapy has also been used following nephrectomy for individuals whose disease is highly likely to recur locally, though this has not been proven to be effective.

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Sirtex/SIR-Spheres

SIR-Spheres microspheres are tiny polymer beads that are loaded with yttrium-90, a radioisotope that emits pure beta radiation. Yttrium-90 has a "half life" of about 2 ½ days, that is, every 2 ½ days the level of radiation falls by one half. The radiation from yttrium-90 is largely confined to a tissue depth of 2 - 3 mm. After injection into the artery supplying blood to the tumors, the spheres are trapped in the tumor's vascular bed, where they destroy the tumor cells by delivering the beta radiation. The radiation is targeted and contained within the patient's body and after 14 days the majority of the radiation effect has occurred. SIR-Spheres microspheres are considered a regional treatment as the radiation is directed to the liver and does not affect other organs in the body.

Further information available at Sirtex USA Sirtex Aust/NZ Sirtex Home

Frequently Used Terminology

A

Ablation: The removal or destruction of tissue or it’s function.

Acute: Symptoms or signs that begin and worsen quickly.

Adenoma: A non cancerous tumor.

Adenopathy: Large or swollen lymph nodes/ glands.

Adjunctive Therapy: Another treatment used together with the primary treatment. It’s purpose is to assist the primary treatment also called adjunct therapy.

Adjunct Therapy: Treatment given after the primary treatment to increase the chances of remission. This may include radiation therapy, biological therapy.

Adrenal Gland: A small gland that secretes hormones. These hormones help control the heart rate, blood pressure and other important body functions. There are two adrenal glands, located on top of each kidney.

Adrenalectomy: Surgery to remove one or both adrenal glands

Allogenic Stem Cell Transplantation: A procedure in which a person receives blood forming stem cells from a genetically similar but not identical donor. This is often a brother or sister but could be a non related donor.

Analgesic: A drug that reduces pain, these include Aspirin, Tylenol, Paracetamol and Ibuprofen.

Ana plastic: A term used to describe cancer cells that divide rapidly and have little or no resemblance to normal cells.

Anemia: A condition in which the number of red blood cells are below normal.

Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor due to chemicals released by the tumor.

Angiogenesis Inhibitor: A substance that prevents the formation of blood vessel. In anticancer therapy and angiogenesis inhibitor prevents the growth of blood vessels from surrounding tissue to a solid tumor.

Anorexia: The loss of appetite

Antibody Therapy: The treatment with an antibody a substance that can directly kill specific tumor cells or stimulate the immune system to kill tumor cells.

Anti-Emetic: A drug that prevents or reduces nausea and vomiting.

Apoptosis: Normal series of events inside cells that leads to it’s death

Ascities: Abnormal build up of fluid in the abdomen that causes swelling.

Atypical: Meaning the cells are Unusual. Generally a vague warning.

Autologous: The infusion of a patients own bone marrow previously removed an stored.

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B

Benign: Not cancerous. Benign tumors can grow large but do not spread to other parts of the body

Bilateral: Affecting both sides of the body

Biopsy: A short operation to remove a small piece of tissue which is sent to a lab to see if it contains cancer cells

Bone Metastases: Cancer that has spread from the original site to the bone

Bone Scan: A technique to create images of bones on a computer screen. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream where it collects in the bones and is detected by the scanning machine

C

Cachexia: Loss of body weight and muscle mass, and weakness that may occur in cancer patients as well as other illnesses

Cancer Vaccine: A vaccine designed to prevent or treat cancer.

Capillary Leak syndrome
: A condition in which fluid and proteins leak out of tiny blood vessels into surrounding tissue. This can be life threatening, resulting in dangerously low blood pressure and may lead to multiple organ failure and shock.

Carcinogen: Any substance that causes cancer.

Carcinogenesis: The process in which normal cells become cancer cells.

Cat Scan, CT scan: Computerized axial tomography scan. This is a series of detailed pictures of areas inside the body taken from different angles. These pictures are created by a computer that is linked to an x-ray machine

Cauterization: The destruction of tissue with a hot instrument, an electrical current. (Usually used in control of bleeding blood vessels during surgery Or can be used to kill tumors).

Cell Proliferation: An increase in the number of cells as a result of cell growth and division.

Cell To Cell Signaling: The transfer of information from one cell to another (seen often in regards to cancer).

Central Nervous System: Defined at the brain and spinal cord

Complete Response: No cancer can be detected after treatment. Note that tumors too small to see may still be present and may cause a later relapse

Contrast: Contrast agent or contrast medium. Any internally administered substance that has a different opacity from soft tissue on radiography or computed tomography. Most contrast used is non-ionic which is easier on the kidney. Here's a link for explanion Contast resolution

Cryoablation: Treatment performed with an instrument that freezes and destroys abnormal tissues.

Cyst: An accumulation of fluid or a semisolid material within a sac ( common in many organs including the kidney)

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D

Debulk: To surgically remove a portion of a tumor to help reduce the pain and symptoms due to the tumor or to improve the quality of life

Diffuse: Not definitely limited or localized; widely distributed.

Disease Free Survival: Length of time after treatment during which no cancer is found. Can be reported for an individual patient or for a study population.

Disease Specific Interval: The percentage of subjects in a study who have survived a particular disease for a defined period of time. Usually reported as time since diagnosis or treatment. In calculating this percentage, only deaths from the disease being studied are counted. Subjects who died from some other cause are not included in the calculation.

Double Blind Clinical Trial: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving until the end of the study.

Dysphagia: Difficulty swallowing

Dysuria: Difficulty or painful urination

E

Embolization: A surgical procedure used to slow the growth or destroy cancer cells by blocking the blood supply to a tumor. The movement of a blood clot, piece of tissue, or pocket of air or gas from where it forms through the bloodstream until it lodges in place, cutting off the flow of blood with its oxygen and tissue nutrients. Catheter embolization is the deliberate introduction of foreign ("embolic") material such as gelatin sponge or metal coils to stop bleeding or cut off blood flowing to a tumor or arteriovenous malformation.

Enucleation: It is the removal of an organ or tumor so that it comes out whole.

Epidural Block: Often used for pain relief. It is an injection of an anesthetic drug into the space between the wall of the spinal canal and spinal cord ( epidural space)

Epithelial: Type of cell that lines the internal and external organs of the body.

Epithelial Carcinoma: Cancer that begins in the cells that line that particular organ. (many RCC tumors begin in the epithelial cells)

ESR: Erthyrocyte sediment rate, a blood test that indicates inflammation, cancer, rheumatoid diseases, diseases of the blood and bone marrow. ( the distance that red blood cells travel in an hour and settle in the bottom of a test tube)

Erythropoietin: A substance that is naturally produced by the kidneys, it stimulates the bone marrow to make red blood cells. It can be made in the laboratory and is called epoetin alfa or epeotin beta.

Exophytic: A tumor that is growing outward

Excisional Biopsy: A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is examined under a microscope.

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F

False-Negative Test Result: A test result that indicates that a person does not have a specific disease or condition when the person actually does have the disease or condition.

False-Positive Test Result: A test that indicates that a person has a specific disease or condition when the person actually does not have the particular disease or condition.

Familial Cancer: A cancer that occurs in families more often then would be expected by chance. These cancers often occur at an early age and may indicate a gene mutation that increases the risk of cancer. They can also be a sign of shared environmental or lifestyle factors.

FDA: U.S. Food and Drug Administration. An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The FDA also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe.

Fentanyl: A narcotic opioid drug that is used for treatment of pain.

Fine-Needle Aspirate: A procedure in which a needle is inserted, under local anesthesia, to obtain a sample for the evaluation of suspicious tissue.

Five-Year Survival: A statistic indicating the percentage of people with a particular type of cancer who are alive 5 years after the initial cancer diagnosis.

Frozen Section
: A technique in which tissue is removed and then quick-frozen and examined under a microscope by a pathologist

G

Gadolinium: A contrast dye that is renal friendly and given intravenously before MRI scans to improve the quality of the picture

Gamma Irradiation: A type of radiation therapy that uses gamma radiation, which is a type of high energy radiation that is different from x-rays. Gamma Knife: Radiation therapy in which high-energy rays are aimed at a tumor from many angles in a single treatment session. The 'Gamma Knife' is a cobalt-60 based radiation treatment machine which delivers radiation beams intersecting at the location of the tumor. This technique requires specialized computer equipment, CT or MRI, and stereo tactic frame to immobilize the head. Higher than normal doses of radiation may be delivered by this method without an increase in side effects. The Gamma Knife delivers 201 beams of highly focused gamma rays to the treatment site.

Gamma Radiation: A very high frequency form of electromagnetic radiation that consists of photons emitted by radioactive elements. Gamma rays can injure and destroy body cells and tissue, especially cell nuclei

Genetic Marker: An alteration in DNA that may indicate an increase in the risk of developing a specific disease or disorder.

Gerota’s Capsule: A fibrous envelop of tissue that surrounds the kidney. This is also called renal fascia and Gerota’s fascia.

Grade: A description of a tumor that refers to how the cancer cells look and behave under a microscope. It describes how different the cancer cells look from normal cells, how quickly the cancer cells are growing and dividing, and how likely they are to spread

Graft–versus–host disease: Is a reaction of the donated stem cells against the patient’s own tissue.

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H

Hand-Foot Syndrome: This is a condition marked by pain, swelling, numbness, tingling or redness of the hands or feet. It can occur as a side effect of some of the anticancer drugs.

Helper T-Cell: A type of white blood cell that helps stimulate immune system reactions. Helper T cells help activate cytotoxic T cells and macrophages by secreting cytokines. They also stimulate B cells to make antibodies.

Hematuria: Blood in the urine either visible with the naked eye or microscopic

High Grade: Cancers that tend to spread quickly

Hilar: This refers to the area where nerves and blood vessels attach to an organ.

Histopathology: The study of cells that are diseased using a microscope.

Hospice: A program that provides special care for people who are near the end of life and their families. This can be done at home, in the hospital or in free standing facilities.

Hypercalcemia: Abnormally amount of calcium found in a blood test

Hydronephroma: Older term for renal cell carcinoma. It is the most common type of kidney cancer. It begins in the lining of the renal tubules in the kidney. The renal tubules filter the blood and produce urine.

Hyperplasia: An abnormal increase in the number of cells in an organ or tissue.

Hyperuricemia: A build up of uric acid in the blood (this is a byproduct of metabolism) It is also a side effect of some drugs to fight cancer

Hyper vascular: Having a large number of blood vessels (common in RCC)

I

Immunotherapy: The artificial stimulation of the body’s immune system to treat or fight disease. The treatment stimulates the body's immune system to produce antibodies to fight disease. Monoclonal antibodies and anti-cancer vaccines are examples of immunotherapy techniques. Also referred to as Biological Therapy

Immune Response: The activity of the immune system against foreign substances.

Immunoassay: A test that uses the binding of antibodies to antigens to identify and measure certain substances. Immunoassays may be used to diagnose disease. This can also provide information regarding the planning of treatment for certain diseases.

Implantable pump: A small device that is installed under the skin to administer a steady dose of a drug used for pain control.

Incisional biopsy: A surgical procedure in which a portion of a lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.

Indolent: A type of cancer that grows slowly

Inferior Vena Cava: The large vein that empties into the heart. It carries blood from the legs and feet and from organs in the abdomen and pelvis.

Intensity-Modulated Radiation Therapy : IMRT. A type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles. This type of radiation therapy reduces the damage to healthy tissue near the tumor.

Investigational Drug: A substance that has been tested in a laboratory and has gotten approval from (FDA) to be tested in people. A drug may be approved by the FDA for use in one disease or condition but be considered investigational in other diseases or condition. Also called an experimental drug.

IVP: Intravenous Pyelogram . A series of x-rays of the kidneys, ureters, and bladder. The x-rays are taken after a dye is injected into a blood vessel. The dye is concentrated in the urine, which outlines the kidneys, ureters and bladder on the x-rays.

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J

Jaundice: A condition in which the skin and the whites of the eyes become yellow, urine darkens and the color of stool becomes lighter than normal. A condition characterized by yellowing of the skin and whites of the eyes, dark yellow urine and clay colored stool that is associated with gallbladder or liver problems.

K

Keloid: A thick irregular scar caused by excessive tissue growth at the site of an incision

Killer Cell: A white blood cell that attacks tumor cells and body cells that have been invaded by foreign substances

L

Lactic Acid Dehydrogenase: One of a group of enzymes found in the blood and other body tissues and involved in energy production in cells. An increased amount in the blood may be a sign of tissue damage and some types of cancer or other diseases. Also called lactate dehydrogenase.

Laproscope: A thin, tube-like instrument used to look at tissues and organs inside the abdomen. It has a light and a lens of the end for viewing. A laproscope has tools to use to remove tissue.

Laparoscopy: Is a procedure that uses a laparoscope inserted through the abdominal wall to examine inside the abdomen.

Laparotomy: Is a surgical incision that is made in the wall of the abdomen.

Latent: Describes a condition that is present but not active or causing symptoms.

Leukocyte: General term for a variety of cells responsible for fighting invading germs, infection and allergy-causing agents. Also called a white blood cell. These cells help the body fight infection and diseases.

Leukopenia: A low number of white blood cells.

Liver Function Test: A blood test to measure the blood levels of certain substances released by the liver. A high or low level of certain substances can be a sign of liver disease.

Liver Metastisis: Cancer that has spread from the original ( primary) site to the liver.

Low Grade: Cancerous cells look nearly normal under a microscope. These are least likely grow and spread rapidly.

Lymph Node: Hundreds of small oval bodies that contain lymph (white blood cells) they act as our first line of defense against infections and cancer

Lytic: The damaged area of a bone that shows up as a dark spot on an X-ray when enough of the healthy bone in any one area is eaten away. Lytic lesions look like holes in the bone and are evidence that the bone is being weakened

Lytic Lesion: Area of bone that has been destroyed do to cancer.

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M

Magnetic Resonance Spectroscopic Imaging: MRSI. A noninvasive imaging method that provides information about cellular activity of a tumor. It is used along with magnetic resonance imaging (MRI) which provides information about the shape and size of the tumor.

Malignance: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body.

Malignant Ascites: A condition in which there is a fluid build up in the abdomen in which there are cancer cells.

Margin: Border of the tissue that is removed in cancer surgery. The margin is described as negative or clean by the pathologist when looking at the specimen under the microscope, suggesting that all the cancer has been removed. If the margin is considered positive it means that the cancer cells are found at the edges and not all the cancer has been visibly removed.

Mean Survival Time: The average time that patients in a clinical study remain alive . The time is measured at time of diagnosis or start of treatment

Metastasis: The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases.

Monoclonal Antibodies: Artificially manufactured antibodies specifically designed to find targets on cancer cells for diagnostic or treatment purposes. Each one recognized a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins or radioactive material directly to the tumor.

Morphine: A narcotic drug used in the treatment of pain.

MRI: Magnetic Resonance Imaging is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases, MRI gives information that cannot be seen on an X-ray, ultrasound or CT scan.

Mutation: Any change in the DNA of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment.

Mylagia: Pain in a muscle or group of muscles.

N

Natural Killer Cell: NK cell. A type of white blood cell that contains granules with enzymes that can kill tumor cells or microbial cells. Also called a large granular lymphocyte.

Necrosis: Refers to the death of living tissue.

Needle Biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration

NED: Standard oncology jargon for No Evidence of Disease - no sign of cancer anywhere . This is not standard oncology jargon!

Neoplasm: An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called tumor.

Nephrotoxic: Poisonous or damaging to the kidney.

NK Cell: Natural killer cell. A type of white blood cell that contains granules with enzymes that can kill tumor cells or microbial cells. Also called a large granular lymphocyte.

NSAIDS: Nonsteroidal anti-inflammatory drug. A drug that decreases fever, swelling, pain, and redness. (Hard on the kidney.)

Nuclear Grade: An evaluation of the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are in the process of dividing or growing. Cancers with low nuclear grade grow and spread less quickly than cancers with high nuclear grade.

O

Objective Response: A measurable response

Observational Study: A type of study in which individuals are observed or certain outcomes are measured. No attempt is made to affect the outcome (for example, no treatment is given).

Off Label: Describes the legal use of a prescription drug to treat a disease or condition for which the drug has not been approved by the US Food and Drug Administration.

Opiate: A drug used to treat pain. It contains opium or a substance made from opium (such as morphine).

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P

Pallitive Care: Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of the disease, side effects caused by treatment of the disease, and psychological, social, and spiritual problems related to the disease or its treatment. Also called comfort care, supportive care, and symptom management.

Paracentesis: Removing fluid from the abdomen using local anesthesia and needle and syringe.

Partial Response: A decrease in the size of a tumor or in the extent of the cancer in the body in response to treatment. This is also called Partial remission.

Pathological Fracture: A break in a bone usually caused by cancer or some disease condition.

Patient Advocate: A person who helps a patient work with others who have an effect on the patient's health, including doctors, insurance companies, employers, case managers, and lawyers. A patient advocate helps resolve issues about health care, medical bills, and job discrimination related to a patient's medical condition. Cancer advocacy groups try to raise public awareness about important cancer issues, such as the need for cancer support services, education, and research. Such groups work to bring about change that will help cancer patients and their families.

Patient-Controlled Analgesia: PCA. A method of pain relief in which the patient controls the amount of pain medicine that is used. When pain relief is needed, the person can receive a preset dose of pain medicine by pressing a button on a computerized pump that is connected to a small tube in the body

Perioperative: Around the time of surgery. This usually lasts from the time the patient goes into the hospital or doctor's office for surgery until the time the patient goes home.

Pericardial Effusion: Increased amounts of fluid within the sac surrounding the heart usually do to inflammation.

Periperal Neuropathy: A condition of the nervous system that cause numbness, tingling, burning or weakness. It usually begins in the hands or feet and can be caused by certain anticancer drugs.

Pet Scan: Positron Emission Tomography Scan. It is a procedure in which a small amount of radioactive glucose is injected into a vein and a scanner is used to make detailed computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells the pictures can be used to find active cancer cells in the body. (Cancer cells/ tumors are usually noted to be at least 1 cm for the cell activity is active enough to have a higher glucose uptake to show up on the scan.)

Phase I Trial: The first step in testing a new treatment in humans. These studies test the best way to give a new treatment (for example, by mouth, intravenous infusion, or injection) and the best dose. The dose is usually increased a little at a time in order to find the highest dose that does not cause harmful side effects. Because little is known about the possible risks and benefits of the treatments being tested, phase I trials usually include only a small number of patients who have not been helped by other treatments.

Phase II Trial: A study to test whether a new treatment has an anticancer effect (for example, whether it shrinks a tumor or improves blood test results) and whether it works against a certain type of cancer.

Phase II/III Trial: A trial to study response to a new treatment and the effectiveness of the treatment compared with the standard treatment regimen.

Phase III Trial: A study to compare the results of people taking a new treatment with the results of people taking the standard treatment (for example, which group has better survival rates or fewer side effects). In most cases, studies move into phase III only after a treatment seems to work in phases I and II. Phase III trials may include hundreds of people.

Photodynamic Therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells.

Placebo: An inactive substance or treatment that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.

Plasmapheresis: The process of separating certain cells from the plasma in the blood by a machine; only the cells are returned to the person. Plasmapheresis can be used to remove excess antibodies from the blood.

Pleural Cavity: The space enclosed by the pleura, which is a thin layer of tissue that covers the lungs and lines the interior wall of the chest cavity.

Pleural Effusion: An abnormal collection of fluid between the thin layers of tissue (pleura) lining the lung and the wall of the chest cavity.

Port - Implanted : A catheter connected to a quarter-sized disc that is surgically placed just below the skin in the chest or abdomen. The tube is inserted into a large vein or artery directly into the bloodstream. Fluids, drugs, or blood products can be infused, and blood can be drawn through a needle that is stuck into the disc. Examples: Port-o-cath, Infusaport, Lifeport

Postoperative: After surgery.

Prednisone: A drug that is used to treat several types of cancer and other disorders. Prednisone also inhibits the body's immune response. It belongs to the family of drugs called steroids.

Prognostic Factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease or the chance of the disease recurring (coming back).

Programmed Cell Death: A type of cell death in which a series of molecular steps in a cell leads to its death. This is the body’s normal way of getting rid of unneeded or abnormal cells. The process of programmed cell death may be blocked in cancer cells. Also called apoptosis.

Progression: Increase in the size of a tumor or spread of cancer in the body.

Progression-Free Survival: One type of measurement that can be used in a clinical study or trial to help determine whether a new treatment is effective. It refers to the probability that a patient will remain alive, without the disease getting worse.

Progressive Disease: Cancer that is growing, spreading, or getting worse.

Protocol: An action plan for a clinical trial. The plan states what the study will do, how, and why. It explains how many people will be in it, who is eligible to participate, what study agents or other interventions they will be given, what tests they will receive and how often, and what information will be gathered.

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Q

Quality Of Life: The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities

R

Radiation Oncologist: A doctor who specializes in using radiation to treat cancer.

Radiation Surgery: A radiation therapy procedure that uses special equipment to position the patient and precisely deliver a large radiation dose to a tumor and not to normal tissue. This procedure does not use surgery. It is used to treat brain tumors and other brain disorders. It is also being studied in the treatment of other types of cancer, such as lung cancer. Also called radiosurgery, stereotactic external-beam radiation, stereotactic radiation therapy, stereotactic radiosurgery, and stereotaxic radiosurgery.

Radiofrequency Ablation: A treatment technique that uses high-frequency alternating electrical current to destroy abnormal cells by heating them with the use of electrodes.

Radiosurgery: A radiation therapy procedure that uses special equipment to position the patient and precisely deliver a large radiation dose to a tumor and not to normal tissue. This procedure does not use surgery. It is used to treat brain tumors and other brain disorders. It is also being studied in the treatment of other types of cancer, such as lung cancer. Also called radiation surgery, stereotactic external-beam radiation, stereotactic radiation therapy, stereotactic radiosurgery, and stereotaxic radiosurgery.

Randomized Clinical Trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial.

Recurrence: Cancer that has returned after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body also called re-current cancer.

Relative Survival: A specific measurement of survival. For cancer, the rate is calculated by adjusting the survival rate to remove all causes of death except cancer. The rate is determined at specific time intervals, such as 2 years and 5 years after diagnosis.

Renal Artery: The main blood vessel that supplies blood to a kidney and its nearby adrenal gland and ureter. There is a renal artery for each kidney. Renal Capsule: The fibrous connective tissue that surrounds each kidney.

Renal Pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder.

Residual Cancer: Cancer cells that remain after attempts to remove the cancer have been made.

Response Rate: The percentage of patients whose cancer shrinks or disappears after treatment.

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S

Sediment Rate ( ESR):The distance red blood cells travel in one hour in a sample of blood as they settle to the bottom of a test tube. The sedimentation rate is increased in inflammation, infection, cancer, rheumatic diseases, and diseases of the blood and bone marrow. Also called erythrocyte sedimentation rate.

Solid Tumors: An abnormal mass of tissue that usually does not contain cysts or liquid areas. Solid tumors may be benign (not cancerous), or malignant (cancerous). Different types of solid tumors are named for the type of cells that form them. Examples of solid tumors are sarcomas and carcinomas

Stable Disease: No new tumors or tumors present have not grown.

Survival Rate: The percentage of people in a study or treatment group who are alive for a given period of time after diagnosis. This is commonly expressed as 5-year survival.

T

Toxicity: The extent to which something is poisonous or harmful.

Transdermal: Absorbed through the unbroken skin. ( some pain relievers are delivered in this fashion)

Transitional Cell: A cell that varies in shape depending on whether the tissue is being stretched. Transitional cells may be stretched without breaking apart. They line hollow organs such as the bladder.

Transitional Cell Carcinoma: A type of cancer that develops in the lining of the bladder, ureter, or renal pelvis (the part of the kidney that collects, holds, and drains urine).

Tumor Load: Refers to the number of cancer cells, the size of a tumor, or the amount of cancer in the body. Also called tumor burden.

Tumor Specific Antigen: A protein or other molecule that is unique to cancer cells or is much more abundant in them. These molecules are usually found in the plasma (outer) membrane, and they are thought to be potential targets for immunotherapy or other types of anticancer treatment.

Tyrosine Kinase Receptor: A drug that interferes with cell communication and growth and may prevent tumor growth. Some tyrosine kinase inhibitors are used to treat cancer.

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U

Urea Nitrogen: A chemical in the blood produced by the breakdown of protein. Urea nitrogen is removed from the blood by the kidneys. Blood urea nitrogen (BUN) tests are sometimes done to see how well the kidneys are working.

Uric Acid: A waste product left over from normal chemical processes in the body and found in the urine and blood. Abnormal buildup of uric acid in the body may cause a condition called gout. Increased levels of uric acid in the blood and urine can be a side effect of chemotherapy or radiation therapy.

V


Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. A vaccine can help the body recognize and destroy cancer cells or micro-organisms.

W

Wedge Resection: A surgical procedure to remove a triangle-shaped slice of tissue. It may be used to remove a tumor and a small amount of normal tissue around it.

Z

Zometa: A drug that is used to treat multiple myeloma and to lower calcium levels in the blood of some cancer patients. It is also used to prevent bone fractures and reduce bone pain in people who have cancer that has spread to the bone. It belongs to the family of drugs called bisphosphonates. Also called zoledronate and zoledronic acid.

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