Back in June, we gave our visitors the opportunity to "Ask the Forbeck Scientific Community" a question they have about cancer and cancer research. Below is a great question we received from Sally J-T.
"What is the main difference between clear cell and non-clear cell (papillary) cancer, and what, if any, new approaches have been made in treating non-clear cell renal carcinoma?"
These tumors are night and day different even though they come from the same region of the kidney. Like small cell lung cancer and nonsmall cell lung cancer--completely different genetically and biologically. Unfortunately for the field (but fortunately for the diversity of biology), the non-clear cell tumors are further heterogeneous (papillary type 1 and 2, and at least 2 or 3 subtypes of type 2, not to mention chromophobe and others). There has only been one advance that has been proven to be beneficial, which is the use of MET inhibitors for papillary type 1. The problem is, the majority of metastatic patients have one of the type 2's. Type 1 is relatively indolent and rarely develops metastatic disease. There are "me too" anecdotes for everything in papillary. VEGFR TKI "can" sometimes work. Immunotherapy "can" sometimes work. We are largely shooting blind when it comes to treating these patients. One rare subtype, but with very aggressive disease, have mutations in krebs cycle enzymes FH or SDH. There is a regimen tested in patients with hereditary forms that has some activity (everolimus plus bevacizumab), but this has not been tested in mainstream populations.
- Kimryn Rathmell, MD, Ph.D., Vanderbilt University
Thanks for your question Sally, and please look for more questions to be answered and posted in the near future.