Dr. Blum Discusses Survival Outcomes for Patients With Renal Medullary Carcinoma

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Kyle A. Blum, MD, MS, says that patients with renal medullary carcinoma have poor prognosis, but anecdotal evidence suggests that survival outcomes may be improving.

Kyle A. Blum, MD, MS, is a urologic surgery resident at The University of Texas MD Anderson Cancer Center. His research focus includes renal medullary carcinoma (RMC), a highly aggressive subtype of renal cancer that typically affects young adults, often African American, with sickle cell trait. In an interview with OncLive®, he highlights survival data for this patient population.

Blum says that treatments that work for other renal cancers, such as renal cell carcinoma (RCC) generally are not effective for RMC. Conversely, treatments that work for RMC typically don’t work in RCC or other kidney malignancies. That may could be due to the presence of sickle cell trait in these patients; however, he says that investigators are not sure why RMC behaves differently than other kidney cancers.

Findings from a retrospective study of 165 patients with RMC published in 2015 showed a median overall survival (OS) of 5.0 months (95% CI, 2.4-7.6). OS was better in nonmetastatic patients compared with those who had advanced disease at diagnosis (17.0 vs 4.0 months, respectively; P = .001).

Most patients with RMC will develop metastases, and the most recent data, published in 2017, show a median survival of approximately 13 months. Improved treatment options and understanding of the disease have extended survival since those data were published in 2017, Blum adds, but it is very difficult to conduct randomized controlled trials with such a small patient population.

Surgery is the primary form of treatment. While patients with RCC generally receive upfront nephrectomy, treatment guidelines for RMC recommend consolidative, cytoreductive nephrectomy, Blum says. The goal, he adds, is to shrink the tumor with systemic therapy before proceeding to surgery.

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