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A new PET scan distinguishes between benign and malignant kidney tumors, according to international research led by Radboud university medical center, published in The Lancet Oncology. In patients with renal cell tumors, the surgeon often removes the kidney or part of it, while it may later turn out that the tumor was benign and the operation therefore unnecessary. The new scan provides information about the nature of the tumor before the operation, and this has a major influence on the treatment.
Renal cell tumors are usually found on a CT or MRI scan. After that, the surgeon in many cases removes the kidney, or part of it. However, in about thirty percent of cases this is unnecessary, because the tumor turns out to be benign. A biopsy may reduce this chance. The doctor then removes a small piece of tumor tissue with a needle and examines it under the microscope. However, a biopsy is invasive and does not always provide a definitive answer about the nature of the tumor. Furthermore, possible metastases may go unnoticed. Radboud University Medical Center therefore developed a new scanning method for better diagnosis of renal cell cancer.
No surgery required
An international team from America, Australia and Europe examined three hundred patients whose doctors suspected renal cell cancer based on a CT or MRI scan. The surgeon removed their tumor. Under the microscope, it turned out whether they had kidney cancer or a benign tumor. In addition, the patients underwent the new scan before their operation, in which girentuximab is injected. This substance binds very specifically to the clear cell type of renal cell cancer, present in more than eighty percent of patients with kidney cancer. Girentuximab contains radioactive zirconium, which makes the substance visible on a PET scan. The new scanning method was co-developed by the company Telix, which supported the study.
The research shows that the new scan detects the presence of clear cell renal cell cancer with a certainty of 85 percent. ‘A great outcome’, says professor of urology Peter Mulders, who led the study. ‘Tumors that show up on this scan are almost always malignant and therefore require surgery. If they do not show up, we can leave the tumor alone in most cases and follow the patients up. This prevents surgery or a biopsy for many patients.’
New treatment
The results of this study have been presented to regulators in Europe and America. If they approve, the new scan will be available to everyone. It will also be included in the guideline. Mulders is confident: ‘Look at prostate cancer, where a comparable PET scan has caused a revolution and replaced CT and MRI scans. That is what I expect from this too.’
The Nijmegen researchers see many more applications of girentuximab, including the detection of metastases of kidney cancer. For example, in another study, a very small metastasis was found in a fingertip using the new scan, which resulted in adjustment of treatment. A new form of treatment is also a possibility. Girentuximab can deliver substances with a therapeutic effect to the kidney tumor. The effects of this radioimmunotherapy are currently being further investigated in patients.
About the publication
This study was published in the Lancet Oncology: [89Zr]Zr-girentuximab for PET–CT imaging of clear-cell renal cell carcinoma: a prospective, open-label, multicentre, phase 3 trial. B. Shuch, A.J. Pantuck, J.C. Bernhard, M.A. Morris, V. Master, A.M. Scott, C. van Praet, C. Bailly, B. Önal, T. Aksoy, R. Merkx, D.M. Schuster, S.T. Lee, N. Pandit-Taskar, A.C. Fan, P. Allman, K. Schmidt, L. Tauchmanova, M. Wheatcroft, C. Behrenbruch, P. Mulders. DOI: 10.1016/S1470-2045(24)00402-9.
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