Chemotherapy after surgery halves risk of rare kidney cancer coming back

March 05, 2020

Chemotherapy halves the risk of a rare form of kidney cancer coming back after surgery, the largest ever trial conducted in the disease worldwide has found.

Patients given chemotherapy within three months of surgery saw the risk of their cancer coming back or spreading reduced and were much more likely to live cancer free for three years or more.

The new results are set to change clinical practice around the world - with chemotherapy being recommended after surgery for all suitable patients with a rare tumour of the urinary system that is large or just starting to spread.

Cancer of the ureter and renal pelvis - starting in the tubes leading from the kidney to the bladder - is relatively rare, with nearly 1,000 people being diagnosed with the disease in the UK each year.

The disease is often diagnosed at a late stage, with over half of patients dying from it, so more effective treatment options are desperately needed.

The POUT trial, led by researchers at The Institute of Cancer Research, London, and the Lancashire Teaching Hospitals NHS Foundation Trust, involved 261 people with cancer of the ureter and renal pelvis.

The trial assessed the benefit of giving people four cycles of a combination of two chemotherapies compared with the current standard of treatment, where patients are actively monitored to spot signs of their cancer coming back after having surgery.

The study was published in the prestigious journal The Lancet Oncology today (Thursday), and was funded by Cancer Research UK.

The researchers found that treating patients with platinum-based chemotherapy after surgery reduced the risk of dying or of ureter and renal pelvis cancer returning by 55 per cent.

They found that 71 per cent of patients given chemotherapy survived for three years or more after joining the trial without their disease coming back, compared with 46 per cent of patients who were on surveillance.

As expected, more people experienced serious side-effects in the chemotherapy group compared with patients under surveillance - around 44 per cent, similar to the rates of side-effects seen in other groups of patients treated with these drugs.

The combination treatment of gemcitabine with platinum chemotherapy used in the study is a low-cost, generic treatment option and is already routinely used on the NHS in a range of other cancers.

The researchers are now working to incorporate the trial results into international clinical practice guidelines, so that chemotherapy after surgery will become the new standard of care.

Next, the team plan to study the benefit of adding immunotherapy or targeted treatment to chemotherapy in this form of the disease.

Professor Emma Hall, Professor of Oncology Clinical Trials at The Institute of Cancer Research, London, who co-ordinated the study, said:

"Our clinical trial has found a considerable benefit of giving chemotherapy to people with cancers that start in the tube leading from the kidney to the bladder - cutting the risk of dying or the disease coming back after surgery by more than half.

"Giving chemotherapy after surgery could give people with this rare form of cancer years more to spend quality time with their families. The results of our study are set to change clinical practice in the UK and internationally, and I'm hopeful that patients will start benefiting very soon.

"Running clinical trials in patients with rare cancers comes with its challenges, including finding enough people to take part - so it's fantastic to see such clear evidence of patient benefit from this study. It shows how important it is to run studies like this to improve treatment options for patients with rarer forms of cancer."

Dr Alison Birtle, Consultant Clinical Oncologist at Lancashire Teaching Hospitals NHS Foundation Trust and the trial's Chief Investigator, said:

"We are very grateful that our participants and the entire uro-oncology community in the UK got behind this study. It is the first to show that there is a real chance for people with upper urinary tract cancer to stay free of their disease for much longer. This type of cancer has always been forgotten and to be able to deliver this, a study that everyone said was impossible, to benefit patients is a privilege."

Retired Eddie Marchant, 74, from Hinckley, Leicestershire, was diagnosed with this type of kidney cancer in 2014 after he noticed blood in his urine.

Doctors successfully treated him with surgery, removing his stage 3 tumour.

The former Royal Artillery non-commissioned officer, who served for 18 years in the Forces, was then invited to join the POUT trial, looking at whether giving chemotherapy after surgery improves outcomes.

He has been cancer free since and said:

"I feel very fortunate to have been invited on to the trial and have had clear scans ever since my treatment.

"I've been able to get on with my life, going on holiday, speed walking to keep fit and enjoying playing and singing some of my favourite Buddy Holly and Eagles tunes."

Dr Rachel Shaw, Research Information Manager at Cancer Research UK, said:

"Thanks to this practice-changing trial, we now have more insight into the best way to treat this rare type of kidney cancer. We hope to see this adopted as the standard treatment in the near future, giving patients the best chance of beating the disease.

"Understanding how to treat rare types of cancer can be harder than it is for more common cancers. However, at Cancer Research UK, we're dedicated to improving treatments for all forms of the disease, no matter how many people are affected."

Institute of Cancer Research

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to