Just a decade ago, patients diagnosed with advanced kidney cancer had few treatment options, and little hope. However, the last decade has seen a relative explosion of new treatments emerge for patients with advanced kidney cancer. First, it was so-called “targeted” therapies, which target key enzymes involved in cancer cell growth and development. Now, many of the major advances are coming in the form of immune therapies that unleash the power of the immune system on cancers.
Also known as renal cell carcinoma, kidney cancer will be diagnosed in more than 63,000 people in the United States this year, making it one of the 10 most common cancers, according to the American Cancer Society.
Kidney cancer immunotherapy
If localized to the kidney, kidney cancer is usually treated with surgery to remove the tumor. However, if the cancer has spread beyond the kidney to other organs — such as lung, bone, liver, or brain — surgery alone is not enough. The last decade has witnessed the development of multiple drugs for use in this situation. Such drugs differ from conventional chemotherapy drugs and are called “targeted,” because they target enzymes involved in the growth and development of cancer cells.
Now, many patients with advanced kidney cancer have an additional option: immunotherapy. One type of immune therapy is “checkpoint” inhibitors. Scientists have learned that tumors produce proteins that serve as “checks” on the body’s natural immune system. Such “checks” prevent the immune system from killing the cancer cells. As it turns out, using antibodies to remove the checkpoints can release the power of the immune system on the cancer cells, leading to better control of the cancer.
Two examples of checkpoint inhibitors are nivolumab and pembrolizumab. Both of these drugs bind to a protein called PD-1, which mediates the checkpoint. In doing so, they liberate T lymphocytes to attack cancer cells. These checkpoint inhibitors are not a cure, but they are another “weapon in the arsenal” for patients and their doctors in the treatment of advanced kidney cancer.
A recent clinical trial found that the combination of nivolumab and another immunotherapy drug, ipilimumab, was significantly more effective than the standard treatment typically given to patients newly diagnosed with metastatic kidney cancer, called sunitinib. Ipilimumab is an immunotherapy previously approved for the treatment of metastatic melanoma. Based on these results, on April 16, 2018, the FDA approved the combination of nivolumab and ipilimumab for patients with previously untreated, intermediate- or poor-risk metastatic kidney cancer.
Progress on other fronts
Not all of the promising new treatments for kidney cancer involve immunotherapy approaches. One new drug for kidney cancer, cabozantinib is a targeted therapy that blocks the activity of proteins involved in cancer cell survival, growth, and metastasis. In December 2017, the FDA approved cabozantinib for initial treatment in patients with advanced kidney cancer.
Also, in 2016, the FDA approved lenvatinib in combination with everolimus for patients with advanced disease who had previously been treated with other drugs. Lenvatinib is a targeted therapy like cabozantinib. Everolimus works by blocking the translation of genes that regulate cancer cell growth.
Kidney cancer immunotherapy clinical trials at Rocky Mountain Cancer Centers
Although tremendous progress has been made in treating kidney cancer, researchers aren’t satisfied, and continue to seek new advances.
Rocky Mountain Cancer Centers is proud to be at the forefront of those advances, participating in several clinical trials to evaluate the effectiveness of kidney cancer immunotherapy drugs.