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I am 56yo male recently diagnosed with stage 4 kidney cancer. Is chemotherapy my only treatment option? Can I be cured?

Kidney cancer is the eighth most common cancer in Singaporean males. It is more common in men than in women. While early stage kidney cancer can be cured with surgery, advanced stage 4 kidney cancer is unlikely to be cured.

Having said that, there has now been many good treatment options available for patients with stage 4 kidney cancer, adding years to a patient’s life.

Historically, kidney cancer is resistant to traditional chemotherapy with response rates of less than 5% (meaning if 100 patients received traditional chemotherapy, only 5 patients would see some shrinkage in their tumor size). Hence, best treatment was early diagnosis followed by surgery as no medication was shown to be effective.

But in the last decade we have witnessed 3 big paradigm shifts in the treatment of patients with advanced kidney cancer.

The first of which was the discovery of oral targeted medications in the early 2000s. These medicines specifically block new blood vessel formation, also known as angiogenesis inhibitors. Kidney cancers are known to activate new blood vessel formation, which lead to cancer growth and spread. By blocking new blood vessel formation, oral targeted medications increased the chance of response from < 5% to 30%.

Then in mid 2010s came the immunotherapy era. These groups of medicines are given by injection. They do not directly kill the cancer but serve only to boost the immune system of the patient, allowing the heightened immune system to go after the cancer. Compared with oral targeted medications, immunotherapy further improved the chance of tumor shrinkage to 40%, with 10% of these responding patients showing complete disappearance of all traces of their cancer.

And most recently, scientific research published early last year, showed that a combination of traditional oral targeted medication plus immunotherapy achieved far superior outcomes to oral targeted medication alone. 60% of kidney cancer patients who received the combination saw their tumors shrinking, resulting in significant improvement in the overall survival of patients.

Thus many good treatment options are available for patients with stage 4 kidney cancer.