Expectations for Postsurgical Treatments in Kidney Cancer

Receiving immunotherapy as postsurgical treatment can help patients with kidney cancer who have high-risk features.

For patients with kidney cancer who require postsurgical treatments, it’s important for them to know what to expect regarding treatment type, side effects and the healing process, an expert told CURE®.

However, not every patient with kidney cancer will undergo postsurgical treatments, Dr. Randall Lee, an assistant professor in the Department of Urology at Fox Chase Cancer Center in Philadelphia, said during an interview with CURE®. He noted that this decision is made based on pathologic features of the kidney tumor, which are abnormal characteristics seen in cells or tissue.

“[Doctors] basically take the patients to surgery if we think that this is a localized kidney tumor — localized, meaning that we don't see anything else on the scans of metastatic disease,” Lee said during the interview. “We want to make sure that we're giving the patients the opportunity for surgical cure in these situations. So, if we think that the tumor and the malignancy are confined to the kidney, we will offer them surgical therapy.”

Postsurgical Immunotherapy for Kidney Cancer

Systemic treatments, Lee said, are the types of postsurgical treatments patients may receive if it’s necessary.

“For patients who have high-risk or aggressive features of their kidney tumor, that is when we would start to recommend treatment for the entire body — systemic treatment options,” Lee explained. “[Although,] it’s not in the form of chemotherapy. It’s actually in the form of immunotherapy.”

Immunotherapy is a type of therapy that stimulates the immune system, which may help the body destroy cancer cells, according to the National Cancer Institute.

Specifically, Keytruda (pembrolizumab), a type of immunotherapy, is the postsurgical treatment patients would receive, according to Lee. Lee noted that previous clinical trials determined that postsurgical treatment with Keytruda improved disease-free survival (time living without signs or symptoms of cancer).

When patients receive their postsurgical treatment plans, they should expect to receive an infusion of Keytruda approximately every three weeks for up to one year.

“During that treatment time, [patients will undergo] surveillance, imaging and scanning,” Lee said.

What Patients Can Expect Before and After Postsurgical Treatment

Before undergoing postsurgical treatment, Lee said there isn’t necessarily anything patients must do. Instead, he explained what patients can do to heal once they’re about to undergo surgery and then after postsurgical treatment.

“Anytime I take a patient to the operating room [for] surgery, I think the healing process after it is the most important to make sure that patients are up and moving around [and] that they’ve recovered,” Lee said. “Basically [making sure] their functional status is as close to baseline … and [that] everything is healed up in preparation [for them] to receive their infusions and their treatments.”

After receiving postsurgical treatment, Lee advised that patients to “keep close contact” with their medical oncologists and urologists, especially regarding side effects. Common side effects patients may experience include fatigue, diarrhea, itchy skin and some joint pain, Lee said.

“The urologist and medical oncologists are helping steer the management of all of this,” Lee emphasized. “It’s really important that if [patients] are having side effects to [postsurgical] treatment that we really want to know. This way, we can get ahead of it, maybe we must talk about changing our game plan as far as which treatment strategy to give [patients].

“If [patients] are having a lot of side effects, we may need to rethink that treatment pathway.”

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