What are the treatment options for an 87-year-old patient with a 10 mm solid renal (kidney) tumor?

From the Guidelines

For an 87-year-old patient with a 10 mm solid kidney tumor, active surveillance is the most appropriate initial management approach. This recommendation is based on the small size of the tumor and the patient's advanced age, where competing health risks often outweigh the risks posed by the small tumor 1. The growth rate of renal tumors is typically slow, with a mean growth rate of 3 mm/year, and progression to metastatic disease is reported in only 1%-2% of patients 1.

Key Considerations

• The patient's overall health status, comorbidities, life expectancy, and personal preferences should be taken into account when making treatment decisions 1.
• Minimally invasive options, such as thermal ablation techniques (e.g., radiofrequency ablation or cryoablation), may be considered if intervention becomes necessary, as they can be performed percutaneously under imaging guidance with minimal recovery time 1.
• Partial nephrectomy (surgical removal of just the tumor while preserving kidney function) may be considered in select cases, but it carries higher surgical risks in elderly patients 1.
• Radical nephrectomy (complete kidney removal) is typically reserved for larger tumors or specific clinical scenarios 1.

Treatment Options

• Active surveillance: regular monitoring with imaging (typically ultrasound or CT scans) every 6-12 months to track tumor growth 1.
• Minimally invasive ablative procedures: radiofrequency ablation (RFA), microwave ablation (MWA), or cryoablation (CA) treatments for patients with small cortical tumors 1.
• Partial nephrectomy: surgical removal of just the tumor while preserving kidney function, considered in select cases 1.
• Radical nephrectomy: complete kidney removal, typically reserved for larger tumors or specific clinical scenarios 1.

From the FDA Drug Label

The median age was 57 years and ranged from 24 to 87 years in the studies. Approximately 86% to 94% of patients in the 2 studies were White. Men comprised 65% of the pooled population. All patients had an ECOG performance status < 2 at the screening visit. Across the 2 studies, 95% of the pooled population of patients had at least some component of clear-cell histology. Most patients enrolled in the studies (97% of the pooled population) had undergone nephrectomy; prior nephrectomy was required for patients enrolled in Study 4 The ORR and DR data from Studies 4 and 5 are provided in Table 12.

Treatment Options for an 87-year-old patient with a 10 mm solid renal tumor:

• Sunitinib is a potential treatment option for renal cell carcinoma (RCC).
• The drug label does not provide specific guidance for an 87-year-old patient with a 10 mm solid renal tumor.
• However, the studies included patients with a median age of 57 years and a range of 24 to 87 years, suggesting that sunitinib may be considered for older adults.
• The decision to use sunitinib should be based on individual patient factors, including overall health, performance status, and tumor characteristics.
• It is essential to consult with a healthcare professional to determine the best course of treatment for this patient 2.

From the Research

Treatment Options for Solid Renal Tumors

The treatment options for an 87-year-old patient with a 10 mm solid renal tumor include:

• Surgery: Most patients can be operated on by surgery or by minimally invasive techniques and methods 3
• Minimally invasive ablative therapies: Such as radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, high intensity focused ultrasound, and laser ablation 4
• Systemic therapy: For patients with metastatic kidney cancer, however, they should be closely monitored for serious adverse events 3
• Percutaneous image guided thermal ablation: An attractive treatment option providing excellent local tumor control, fewer complications, better preservation of the renal functions, faster recovery and shorter hospital stay 4
• Partial nephrectomy: Remains the gold standard, but image-guided, percutaneous ablation for RCC can result in very similar outcomes 5

Considerations for Treatment Planning

When planning treatment for an 87-year-old patient with a 10 mm solid renal tumor, the following factors should be considered:

• General status and comorbidity of the patient: Proper assessment is essential for treatment planning 3
• Patient age and life expectancy: Influence the decision-making tree for percutaneous ablation 5
• Renal function: An important factor in the decision-making tree for percutaneous ablation 5
• Risk of metachronous lesions: An important factor in the decision-making tree for percutaneous ablation 5

Efficacy and Safety of Ablation

The efficacy and safety of ablation for renal cell carcinoma (RCC) are:

• Efficacy: 90%-95% 5
• Complication rate: 6%-7% 5
• Long-term cancer control data: Similar to those achieved with traditional nephron-sparing surgical options 6