Renal medullary carcinoma is a very rare subtype of renal cell carcinoma. This is a very devastating tumour, and it affects mostly patients of African descent, and patients with the sickle-cell trait. These patients in general have a survival of about one year from diagnosis, which is very devastating in this typically young patient population.
A recent international study published in the British Journal of Urology International by researchers at the University of Texas MD Anderson Cancer Center looked at 52 patients with renal medullary carcinoma, recruited over a 15-year period. Median overall survival for patients in the study was only about 13 months, barely over a year. However, the most important findings from the study were that patients who were treated with targeted therapies, such as tyrosine kinase inhibitors, VEGF-receptor inhibitors, or mTOR inhibitors, did not respond to these treatments. The patients who did have a response to treatment were the ones who received cytotoxic chemotherapy, such as gemcitabine/cisplatin, or MVEC, or carboplatin/paclitaxel. In addition, patients who were able to have surgery had better survival than patients who did not.
The researchers concluded that if the patient has a good performance status, and is a surgical candidate, and has limited metastatic disease, they typically undergo surgery first, followed by chemotherapy. If the patient has a poor performance status, or visceral metastases, or they’re not surgical candidates, typically they will get chemotherapy first, and then later on they will be reassessed. If they have had a response and their performance status is good, surgery might be offered afterwards.
Read more here and see a video interview with Dr Jose Antonio Karam, Assistant Professor Department of Urology, Division of Surgery, at the University of Texas MD Anderson Cancer Center.