The State of The Fight
Turning Every Kidney Cancer Patient into a Survivorby Dr. Sumanta Kumar Pal
I began my college career at the age of 13. To be quite honest, at the time that I was applying to medical school at the age of 15 or 16, I really didn’t have a great sense of why I wanted to go into medicine, let alone Oncology. Having said that, I fell in love with the field in medical school at UCLA, and at that point in time, there were also a lot of exciting developments in the field of cancer research, notably the development of targeted therapies for breast cancer and certain types of leukemia. I also feel that it’s a field where compassionate care is required and where there’s a huge amount of scientific intrigue.
It’s critical to know that kidney cancer affects about 65,000 people each year in the US, and about 15,000 people will actually die from kidney cancer on an annual basis. Some of the causes include smoking, obesity, high blood pressure, and a family history of the disease. Symptoms to look out for include blood in your urine, incessant pain in your side, a lump or mass in your side or abdomen, sudden weight loss, fever, and fatigue. If you notice any of these, be sure to speak with your doctor. It’s key to keep in mind that in the setting of kidney cancer, we’re seeing a rise in the incidence of the disease by about 3% per year, which we think is probably due to improvements in CT scans and MRIs that are picking up more tumors.
The main goal of my research is to identify new targets for kidney cancer therapy and to develop new drugs. It’s been amazing to me that since 2005 we’ve actually had seven new drugs approved by the US FDA. That said, I don’t think we’re anywhere near curing kidney cancer. Typically, when a patient walks into my clinic with disease that’s spread to his or her lungs or bones or other organs, I’m forced to deliver a prognosis of two to three years. I would certainly like to improve upon this by offering new and novel therapies.
The biggest challenge every researcher across the US and I face nowadays is the lack of funding for research. Government funding for research has been slashed and as such, we are always looking for new and alternative sources of funding. This is why efforts such as Stand Up To Cancer are so critical to the success of kidney cancer research here and elsewhere.
What really keeps me going in the clinic on a day-to-day basis is that fact that although there certainly are cases in which we are not able to dramatically alter outcomes, I do have a population of patients in my clinic who represent long-term survivors. These are individuals who were given a prognosis of anywhere between six months and two to three years who are alive years and years later. Seeing them grow, seeing their families grow, watching their kids grow older — it really provides a sense of personal achievement. I want to keep at this job so that I can turn every patient into a long-term survivor.
I’d like to tell the story of a real patient, whom we’ll call “Judy.” This is a patient who had a diagnosis of kidney cancer in her mid-60s. Very pleasant lady, very limited other health-related problems. When Judy’s kidney cancer was diagnosed, it had already spread to several areas in her lungs.
We have a number of targeted therapies that are currently available for metastatic kidney cancer, but Judy blew through these traditional treatments very quickly. She was on her first- line of therapy for only two months at which point the cancer continued to grow. She was on her second-line of therapy for a total of three months, but the cancer grew beyond that. Now, I typically provide a prognosis of around two years for kidney cancer therapy, but this was three years ago. You may ask, “How did this patient last despite having that early progression on the first two lines of therapy?” As it turns out, she enrolled on a clinical trial that we had written at the time at City of Hope, and had an outstanding response that lasted for an extended duration. As such, because of her participation in clinical trials, she was able to outlive the prognosis typically associated with renal cell carcinoma and really surprised us by having an outstanding response despite that initial poor response to her first two lines of therapy.
I think the biggest breakthrough that’s necessary is the pairing of studies of new therapies with studies of kidney cancer tissue so we can derive an understanding of why patients with kidney cancer with certain mutations or other genetic changes may have a more profound response to a given therapy and this way we can really personalize medicine. For instance of a patient walks into my clinic with a given mutation, we might be able to target that patient with a drug that is unique to that mutation.
In the mean time, to help prevent kidney and other cancers, people should be sure to quit smoking, increase the amount of fruit and vegetables in their diet, and maintain a healthy blood pressure. We are all part of this fight!
Sumanta Kumar Pal, M.D., is an assistant professor in the Department of Medical Oncology & Therapeutics Research and co-director of the Kidney Cancer Program at City of Hope. Having been appointed to the faculty for just over three years, Pal has been extremely productive, writing for more than 60 peer-reviewed publications, as well as numerous presentations in national meetings, while seeing approximately 50 patients a week.
Pal began his college career at the age of 13 through the California State University, Los Angeles Early Entrance Program. He began medical school at the age of 17 at the University of California, Los Angeles (UCLA), where he developed an immediate interest in cancer research. Working in the laboratory of Dennis Slamon, M.D., Ph.D., Pal examined the breast cancer drug trastuzumab, performing laboratory-based studies to elucidate mechanisms of resistance to the agent. He continued this work during the course of his residency training at UCLA.
After completing his residency, Pal transitioned to City of Hope where he trained under Robert Figlin, M.D., developing clinical trials and translational studies for genitourinary cancer, principally in the domain of renal cell carcinoma and prostate cancer. He has garnered numerous awards to support his work, including grants from the California Breast Cancer Research Program, the National Comprehensive Cancer Network and the National Institutes of Health. He recently received a Young Investigator Award from the Kidney Cancer Association to recognize his outstanding research in this domain, and further received the 2012 Charles A. Coltman Translational Research Award from the Southwest Oncology Group to support his work in bladder cancer.
Dr. Pal’s vision is to take discoveries made in the laboratory and translate these findings as quickly and efficiently as possible into tangible benefits for patients.