Hello again Victor,
My husband came across this article regarding metastatic renal cell carcinoma and the use of the drug sunitinib (Sutent), with or without 'cytoreductive nephrectomy', which I assume means the removal of a kidney. The article is from the Aug. 2, 2018 issue of the New England Journal of Medicine. Thought you might be interested since you are also discussing these sorts of kidney issues with your doctors.
Reference:
Méjean, A, et al, "Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma," New England Journal of Medicine, Aug 2, 2018 (abstract)
Abstract:
Background - Cytoreductive nephrectomy has been the standard of care in metastatic renal-cell carcinoma for 20 years, supported by randomized trials and large, retrospective studies. However, the efficacy of targeted therapies has challenged this standard. We assessed the role of nephrectomy in patients with metastatic renal-cell carcinoma who were receiving targeted therapies.
Methods - In this phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with confirmed metastatic clear-cell renal-cell carcinoma at presentation who were suitable candidates for nephrectomy to undergo nephrectomy and then receive sunitinib (standard therapy) or to receive sunitinib alone. Randomization was stratified according to prognostic risk (intermediate or poor) in the Memorial Sloan Kettering Cancer Center prognostic model. Patients received sunitinib at a dose of 50 mg daily in cycles of 28 days on and 14 days off every 6 weeks. The primary end point was overall survival.
Results - A total of 450 patients were enrolled from September 2009 to September 2017. At this planned interim analysis, the median follow-up was 50.9 months, with 326 deaths observed. The results in the sunitinib-alone group were noninferior to those in the nephrectomy–sunitinib group with regard to overall survival (stratified hazard ratio for death, 0.89; 95% confidence interval, 0.71 to 1.10; upper boundary of the 95% confidence interval for noninferiority, ≤1.20). The median overall survival was 18.4 months in the sunitinib-alone group and 13.9 months in the nephrectomy–sunitinib group. No significant differences in response rate or progression-free survival were observed. Adverse events were as anticipated in each group.
Conclusions - Sunitinib alone was not inferior to nephrectomy followed by sunitinib in patients with metastatic renal-cell carcinoma who were classified as having intermediate-risk or poor-risk disease. (Funded by Assistance Publique–Hôpitaux de Paris and others; CARMENA ClinicalTrials.gov number, NCT00930033.)
Forums
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
Hello Nancy,
Thank you for sharing this information. As you can imagine, I have a number of appointments and ongoing discussions with the doctors and specialists prior to my surgery in September.
I hope very much that the optimism I am hearing is well founded. Yesterday I was advised to continue the Pomalyst this month and to temporarily discontinue treatment 5 days before surgery. I am also advised that if the kidney and tumor are removed intact there may be no need for further treatment. My concern is that if this secondary tumor has appeared, could there be other problems in the future? We must cross these bridges as we come to them.
Kind Regards,
Victor L.
Thank you for sharing this information. As you can imagine, I have a number of appointments and ongoing discussions with the doctors and specialists prior to my surgery in September.
I hope very much that the optimism I am hearing is well founded. Yesterday I was advised to continue the Pomalyst this month and to temporarily discontinue treatment 5 days before surgery. I am also advised that if the kidney and tumor are removed intact there may be no need for further treatment. My concern is that if this secondary tumor has appeared, could there be other problems in the future? We must cross these bridges as we come to them.
Kind Regards,
Victor L.
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Victor L - Name: Victor L
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2012
- Age at diagnosis: 58
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
A brief update on my current situation:
I will be in hospital for several days for the removal of one kidney. The hematologist spoke with me this week and explained that the kidney tumor has been caused by one of the myeloma treatments which I have received. He said there is a good chance that the surgery will be 'curative' and that I will then continue with the pomalidomide, which has virtually eliminated the original myeloma.
I will update as soon as possible. At this point I feel very well.
Best Wishes to you all
Victor L
I will be in hospital for several days for the removal of one kidney. The hematologist spoke with me this week and explained that the kidney tumor has been caused by one of the myeloma treatments which I have received. He said there is a good chance that the surgery will be 'curative' and that I will then continue with the pomalidomide, which has virtually eliminated the original myeloma.
I will update as soon as possible. At this point I feel very well.
Best Wishes to you all
Victor L
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Victor L - Name: Victor L
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2012
- Age at diagnosis: 58
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
Best of luck for surgery!
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Paula Oliveira - Who do you know with myeloma?: Mother
- When were you/they diagnosed?: Nov 2014
- Age at diagnosis: 64
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
I have returned home from hospital having had my right kidney removed. All of the discussions with the doctors and surgeons seem to be positive, with follow-up appointments and examinations arranged at one month and three months.
I awoke in the recovery room seven hours after entering the operating room. My initial observation was that the itching in my forearms which had troubled me for many months had disappeared and has so far not returned. All of the blood tests since surgery have been normal and I will restart the Pomalyst next week if my hematologist is happy with that.
Kind Regards from a slightly tired Victor L
I awoke in the recovery room seven hours after entering the operating room. My initial observation was that the itching in my forearms which had troubled me for many months had disappeared and has so far not returned. All of the blood tests since surgery have been normal and I will restart the Pomalyst next week if my hematologist is happy with that.
Kind Regards from a slightly tired Victor L
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Victor L - Name: Victor L
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2012
- Age at diagnosis: 58
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
Victor,
I just finished reading all your posts on this topic. I want to say that you have been extremely generous and thoughtful in sharing your progress with us.
Your positive, but realistic, attitude is an example for us all.
Please accept my heartfelt wishes for your continued success!
I just finished reading all your posts on this topic. I want to say that you have been extremely generous and thoughtful in sharing your progress with us.
Your positive, but realistic, attitude is an example for us all.
Please accept my heartfelt wishes for your continued success!
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Pepperink - Name: Jimmie
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: June 16, 2017
- Age at diagnosis: 66
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
Hello Pepperink
It is so kind of you to express your appreciation, and I hope you will have great success with your myeloma treatment.
One of our best defenses against this illness is having access to modern diagnostic equipment, such as CT scanners, and my advice is to take advantage of these facilities, even the humble ultrasound can detect a dangerous secondary tumor which, like my kidney malignancy, can remain hidden for many months, even years. Lack of severe pain does not always mean that all is well!
Once again my friend, thank you for your kind words and I send you my very best wishes for a good outcome.
Victor L
It is so kind of you to express your appreciation, and I hope you will have great success with your myeloma treatment.
One of our best defenses against this illness is having access to modern diagnostic equipment, such as CT scanners, and my advice is to take advantage of these facilities, even the humble ultrasound can detect a dangerous secondary tumor which, like my kidney malignancy, can remain hidden for many months, even years. Lack of severe pain does not always mean that all is well!
Once again my friend, thank you for your kind words and I send you my very best wishes for a good outcome.
Victor L
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Victor L - Name: Victor L
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2012
- Age at diagnosis: 58
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
It's great to hear from you, Victor. I'm so glad to learn that you've gotten through your kidney surgery and there don't seem to have been any major negative effects. I hope that everything is going well now that you've restarted Pomalyst.
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
Hello Cheryl G,
Thank you for your post and good wishes. It is almost three weeks since my surgery, and I am surprised at how the modern surgical and after-care techniques have enabled me to make such a fast recovery. The area of the surgery, the right abdomen, is obviously rather sensitive, but my skin is healing well with the help of the nurse who visits every two days.
I received a telephone call from my hematologist yesterday instructing me to re-start the Pomalyst treatment in two weeks time. The blood test last week indicated that all is well apart from reduced kidney function, which is to be expected.
Thank you again for your interest.
Kind regards,
Victor L
Thank you for your post and good wishes. It is almost three weeks since my surgery, and I am surprised at how the modern surgical and after-care techniques have enabled me to make such a fast recovery. The area of the surgery, the right abdomen, is obviously rather sensitive, but my skin is healing well with the help of the nurse who visits every two days.
I received a telephone call from my hematologist yesterday instructing me to re-start the Pomalyst treatment in two weeks time. The blood test last week indicated that all is well apart from reduced kidney function, which is to be expected.
Thank you again for your interest.
Kind regards,
Victor L
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Victor L - Name: Victor L
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2012
- Age at diagnosis: 58
Re: Pomalyst, cyclophosphamide & dexamethasone treatment
It is now six weeks since my kidney surgery and the scars are starting to fade away and there is no longer any pain or discomfort.
This week I have had my first post-op examination and ultrasound. The surgeon is happy with everything and has asked me to return for a further check up in six months. Also, this week I have had my full blood test and electrophoresis test. The kidney function is down, which is to be expected with only one kidney. Also, there is a slight increase in the beta 2 proteins. This is not surprising in view of the fact that the Pomalyst was stopped nearly two months ago and was restarted a week ago. My next hematology appointment will be in January 2019 when I will also have a full cardiology examination, including the 24-hour monitoring.
Best Wishes to you all,
Victor L
This week I have had my first post-op examination and ultrasound. The surgeon is happy with everything and has asked me to return for a further check up in six months. Also, this week I have had my full blood test and electrophoresis test. The kidney function is down, which is to be expected with only one kidney. Also, there is a slight increase in the beta 2 proteins. This is not surprising in view of the fact that the Pomalyst was stopped nearly two months ago and was restarted a week ago. My next hematology appointment will be in January 2019 when I will also have a full cardiology examination, including the 24-hour monitoring.
Best Wishes to you all,
Victor L
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Victor L - Name: Victor L
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2012
- Age at diagnosis: 58
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