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Arizona woman free of kidney cancer after innovative chemo

Posted 1/29/20

Decades of advancements building upon each other — both in oncology and operating room technology — are providing surgeons the ability to treat kidney cancer with minimally invasive cuts …

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Arizona woman free of kidney cancer after innovative chemo

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Decades of advancements building upon each other — both in oncology and operating room technology — are providing surgeons the ability to treat kidney cancer with minimally invasive cuts while preserving the function of compromised organs.

Benjamin Lee, MD, is chief of urology at Banner - University Medical Center Tucson, and his patient, Patricia Cruz, is a living example of the ability to minimize the risks of renal failure and dialysis, while curing cancer.

Before meeting Dr. Lee, Ms. Cruz experienced several severe urinary tract infections — or UTIs. She first tried to treat the UTIs on her own, going to a gynecologist and being told everything was normal.

But in March 2018 she had a sharp pain in her lower right abdomen that lasted for about an hour. She also threw up.

That’s when her children decided to take her to the hospital and encouraged her to seek medical help.

“I am so blessed. I thank them every day,” Ms. Cruz said about her children when interviewed by the Daily Independent Jan. 24. “Just yesterday I was telling them how blessed I was to have them.”

At Banner, Dr. Lee discovered large tumors on Ms. Cruz’s kidneys, as well as a large staghorn calculus — a kidney stone the size of a golf ball. Dr. Lee said that was causing the UTIs.

“The one on the right was about the size of a football; the one on the left was about the size of a grapefruit,” he said. “I thought to myself, ‘We can help her.’”

But before he could remove the tumors, Dr. Lee needed to reduce them in size.

“We can shrink that tumor in order to save the kidney,” Dr. Lee said. “Our job as urologists is really to save the kidney and minimize those risks of dialysis.”

But first, he needed to treat the UTIs. Dr. Lee worked to clear the infection from the stone. Once the stone was cleared, he used tyrosine kinase inhibitors — a form of chemotherapy — to shrink the tumors and save 50% of the left kidney.

Dr. Lee said the TKI shrinks the tumor by inhibiting its tyrosine kinase pathway, which inhibits cancer cell growth. The chemotherapy essentially blocks the pathway with resultant shrinkage of the tumor, making resection of the cancer possible, while preserving renal function optimally at the same time.

After staging the left kidney — letting it recover — he then treated the right kidney in the same manner.

“One of the innovative factors that was performed at the Arizona Cancer Center here at Banner – University Medical Center Tucson was to downsize and shrink the tumor using tyrosine kinase inhibitors prior to robotic surgery,” Dr. Lee said. “In the past, total (radical) removal of the kidney would likely have to be performed, due to the massive size and growth of the tumor. After shrinking the tumor 35 percent, we performed a robotic partial nephrectomy, which is surgery to cut out the cancer and save 50 to 75% of the normal kidney.”

Surgery involved use of the da Vinci Xi Robotic Surgical System. It allows for minimally invasive surgery utilizing smaller cuts and a highly precise procedure performed by surgeons using a computer interface with highly detailed 3D imaging.

The combination of the chemotherapy and the da Vinci system allowed Ms. Cruz to recover faster and, she said, almost pain-free. Ms. Cruz was prescribed pain prescriptions, but she said she hasn’t had to use them.

She is also cancer free.

“I’ve asked the doctors, ‘Are there any restrictions, a diet?’” she said. “‘No, you just go on with your normal life.’ I haven’t had any restrictions. Just living my life since before the diagnosis. I just saw my nephrologist. My kidney is working at 70%. They’re so amazed at my recovery. Saving 50 of one and 55 of the other, it’s been an amazing situation that I was in. I’m just so blessed.”

In addition to reduced pain, Dr. Lee said, recovery time is only a couple weeks instead of several months.

“Because the incisions are smaller, the amount of pain is less,” Dr. Lee said. “Because the amount of pain is less, the amount of pain medication required is less and the recovery time is quicker.”

Dr. Lee said that they’ve had about 15 patients who have had this type of successful treatment. However, he stresses that this treatment is not for everyone with kidney cancer.

“The main thing is if the patient had a tumor such that treatment would put them at higher risk of renal failure and dialysis,” Dr. Lee said. “Those are people who are at higher risk for kidney failure that we would try to shrink tumor via the TKI. That’s the imperative indication.”

The following people are ideal for the TKI treatment:

  • Patients who have solitary kidney, who may have had one kidney already removed for renal cell carcinoma, and have a larger tumor on remaining kidney that would put them at higher risk for renal failure after surgery;
  • Patients with a component of chronic renal failure;
  • Patients with tumors on both kidneys, which make surgical resection — i.e. partial nephrectomy — difficult because of size, location, and degree of involvement of the kidney; and
  • Patients with pre-existing medical renal disease which puts them at higher risk for renal failure when the tumor is resected, because of the smaller amount of kidney mass/parenchyma remaining.

“It’s always better to save the native kidney,” Dr. Lee said when asked why this form of treatment is an alternative to a transplant and dialysis. He said dialysis is usually permanent and lifelong, with patients having to spend about four hours a day, three days a week hooked up to a machine.

“It affects quality of life,” Dr. Lee continued. “Even if one has a kidney transplant, then you have to take medication for the rest of your life. It’s better for quality of life to preserve the kidneys that one was born with, that god gave to at birth.”

Kidneys are important to the body. They excrete waste products, regulate fluids and secrete hormones that help stimulate red blood cell growth and prevent anemia.

“When kidney function is compromised, all those functions are too,” Dr. Lee said. “One has to limit the amount of fluid that you drink. And everything becomes impacted when the kidneys don’t function well. The worse the kidney function is the higher the risk of a heart attack, the higher the risk of death from heart disease.

“Kidney function and cardiac function are directly related. That’s another reason why one wants to maintain intrinsic kidney function as well as you can.”

While the TKI treatment has been a success in people like Ms. Cruz, Dr. Lee is also looking towards the future with another method that may be a tad better.

“The FDA has had another category of medication called checkpoint inhibitors,” he said. “It’s been approved within the last year. It’s the same type of chemo that Jimmy Carter had when he had his melanoma metastasized to his brain. We’re looking to see if we can achieve the same with checkpoint inhibitors. That’s probably the future.”

Dr. Lee is showing his advancements to fellow urologists as an option to treat kidney cancer and avoid the need for a kidney transplant or dialysis due to renal failure. Prospective patients can schedule an appointment with Dr. Lee and his team.