Papillary Type, Spread to Lymph Node(s)

14 Posts | Page(s): 1 2  Next 

Papillary Type, Spread to Lymph Node(s)

by Annettel on Fri Jun 24, 2005 12:00 AM

Quote | Reply
My father has been diagnosed with Renal Cell Carcinoma - the type is Papillary. He has a small tumor in one kidney and it has spread to a lymph node or nodes in the area. The oncologist in our town recommended surgery and then the interferon and/or interleukin shots. We are going to the Mayo clinic for another opinion. I am also debating whether it would be worth going to MD Anderson Cancer center. We are wanting to start treatment as soon as possible, but I don't want to miss an opportunity for treatment which may be more effective. Any advice as to the resources of Mayo clinic vs. other centers, plus any other emotional support would be so appreciated. Thank you.

Papillary Renal Cell Carcinoma

by Trishpm on Tue Jun 28, 2005 12:00 AM

Quote | Reply
There are two types of papillary renal cell cancer, Type II is very aggressive; Type I less so. For another opinion, you should consider calling the National Cancer Institute in Bethesda, Maryland (call 1-800-4-CANCER to see if they have a program that applies to your father), or Dr. Janice Dutcher at Our Lady of Mercy in the Bronx, or Dr. Robert Amato at Methodist Hospital in Houston. There is an email support list specific to renal cell carcinoma with many members with papillary type. To join, go to http://cancerguide.org/kofaq/.

Papillary Rcc

by Rccdoc on Wed Jul 06, 2005 12:00 AM

Quote | Reply
There are two types of Papillary RCC, however most pathologists are not skilled enough to recognize the two different types, and at present it does not appear that it ultimately matters which type one has. The two different types are associated with different genetic abnormalities (i.e. c-met mutations) which may serve as a target for new drugs. I strongly discourage you from receiving therapy with IL-2 or IFN. There is strong evidence from publicatons fromt the Cytokine Working Group, as well as a publication from Rob Motzer at MSKCC that non-clear cell histologies do not benefit from either IL-2 or IFN. If you have an appointment at MD Anderson, they will concur with this (the two medical oncologists there are Tannir and Jonasch, and the main surgeon is Chris Wood). I know all three personally and they are great doctors who will not lead you down the wrong path. Surgery is the best option even if the tumor has spread outside the kidney. For cancers that can not be all cut out, the best options are to pursue enrollment on a clinical trial (usually a chemotherapy based clinical trial) or to receive the chemotherapy off-label (i.e. none of the chemo drugs will be FDA approved for papillary RCC, as it is a very rare cancer--i.e. between 6-15% incidence). The main chemo drugs with activity are capecitabine/gemcitabine and adriamycin/gemcitabine. The new drugs for clear cell RCC (Bayer and Pfizer) appear to have some activity against the non-clear cell histologies as demonstrated in early phase clinical trials. There will not be a clinical trial designed to answer the question specifically. However, because of the potential for some benefit in non-clear cell histologies, the expanded access protocols/compassionate use for both the bayer and pfizer drugs allow patients with non-clear cell/papillary histologies to receive the drug. These protocols have been approved by the FDA.

Papillary Rcc

by Rccdoc on Wed Jul 06, 2005 12:00 AM

Quote | Reply
Jan Dutcher (NY) and Rob Amato (Houston) are great docs. And I also know both of them very well. They both have been involved in clinical trials of chemotherapy drugs for variant/non-clear cell RCC. (Gem/Cape, Gem/Adria). At present there is an ECOG trial evaluating chemotherapy and it may still be open.

Papillary

by Annettel on Sat Jul 09, 2005 12:00 AM

Quote | Reply
Thank you. We are down to two choices - the Bayer drug and Enrlotinib. The Docs we saw are hesitant to give a specific direction, so we feel like we are throwing a dart to pick the best one. I think the Bayer drug may be less toxic, so this may be the way we go. Do you know anything about Erlotinib? I'm trying to hope for the best. Thanks again

Papillary

by Rccdoc on Sat Jul 09, 2005 12:00 AM

Quote | Reply
Personally, I would recommend the bayer drug (sorafenib) which as you know, will be available as compassionate use. I just opened it this past week, and there are several places around the country. I would also recommend trying the pfizer drug (sutent) once that becomes available compassionate use which will happen in the next 1-2 months. So if the bayer drug does not work, then you can try the pfizer drug. The bayer drug is extremely well tolerated. My only problem using Tarveva is that the single agent trials in RCC have all been negative. I would put that third on the list: Sorafenib Sutent Tarceva (erlotinib) Chemotherapy (Gemcitabine/Adri, or Gem/Xeloda) Best regards, and god bless.

Papillary Rcc

by Splicemix on Sun Jul 24, 2005 12:00 AM

Quote | Reply
Just to address some issues: Surgery for metastatic RCC is marginally beneficial for survival, but the New England Journal of Medicine study did not subtype kidney cancer into its histologic subtypes. Thus, it seems likely that the study may apply more to clear cell RCC (more common). Situation for papillary RCC seems unclear, and I would be hesitant before recommending cytoreductive nephrectomy. Secondly, a new molecular subtyping of papillary RCC has been proposed - 'class 1' and 'class 2' RCC (see the AACR Journal "Cancer Research" July 1st 2005), the latter having a much worse prognosis. This classification is likely to be achievable in an ordinary hospital lab setting using immunohistochemistry. It seems from the molecular studies that doxorubicin aka adriamycin and gemcitabine may possibly be active in class 2 tumors, similar to the recommendation of one other poster here. This does not of course constitute medical advice in any way.

Papillary

by Rccdoc on Sun Jul 24, 2005 12:00 AM

Quote | Reply
I completely disagree with you. The ability to separate Type I and Type II Papillary RCC still remains a significant problem. Arguably the leading pathologist in the world on RCC is Victor Reuter at MSKCC in New York City and I can provide you his number so he can tell you himself. Right now, there is no clinical significance of subtyping out papillary RCC. And there is NO STANDARD THERAPY for papillary RCC. That means your doctor can only provide you drugs off-label which means non-reimbursed by most insurance companies. There is minimal clinical trial information and the bulk of patients enrolled on the gem/adria and gem/xeloda clinical trials were not papillary cancer. I know the authors personally. The largest trial by Walter Stadler from CALGB did not track histology. I am not talking about cytoreductive nephrectomy which is the standard of care although debated in some circles. I am talking about metastectomy. Which is a real option. The best options are outlined above in my previous email. If you asked the top 10 leading RCC doctors, which I am one of, they would agree. Take it or leave it. It is not worth debating.

Papillary

by Splicemix on Mon Jul 25, 2005 12:00 AM

Quote | Reply
This discussion appears to be veering into grounds that are not directly relevant to the initial poster's question, but in any case, I think we can all agree that: (a) there is minimal data to go by, so almost all recommendations will be experience/eminence-based, so do find an experienced RCC doctor. The RCC mailing list for patients usually provides several recommendations. (b) conventional immunotherapy is not recommended, since durable responses are seen primarily in clear cell RCC. We can only hope for the best re: targeted therapy, and I do agree with your suggestion of sorafenib as a first line. Now for what we are likely to disagree over, (a) Sutent as a second-line drug - I note that of the 2 Phase II studies, the 2nd study was restricted to clear cell RCC, in comparison to the initial Phase II which had 13% non-clear cell histologies. One investigator mentioned on questioning that he did not see much benefit in the non-clear cell histologies, but of course, you may have access to some data I do not. (b) I do agree that classification into Type 1 and Type 2 (the Delahunt classification) can be challenging; nonetheless, a careful reading of the literature unearths multiple articles from several centers suggesting that CK7 is a useful marker. I would recommend a reading of the Cancer Research paper for those interested in the new proposed classification, since it proposes a return to a grade-based prognostication, supported by immunohistochemistry. It is probably of prognostic, but not currently therapeutic significance. I would however as an oncologst actively seek out an experienced uropathologist to classify my patient's RCC.

Papillary

by Trishpm on Mon Aug 08, 2005 12:00 AM

Quote | Reply
With rare subtypes, there frequently is not enough evidence to really know what is most effective, and having a docter experienced in treating rare subtypes is vital. There has been a report that the three papillary patients on the Iressa/interferon arm of Dr. Amato's trial of Iressa/interferon vs Gleevec/interferon have had 70% tumor shrinkage in three months. He is switching the papillary patients on the Gleevec arm to Iressa/interferon.
14 Posts | Page(s): 1 2  Next 
Subscribe to this message board discussion

Latest Messages

View More

CancerCompass Survey

If you were considering traveling for cancer treatment, which headline would you find more interesting?

Get $75 for taking a research survey

We care about your feedback. Let us know how we can improve your CancerCompass experience.