Kidney cancer—also called renal cell cancer—is one of the major types of cancer for which new immune-based cancer treatments are currently in development. This page features information on kidney cancer and immunotherapy clinical trials for kidney cancer patients, and highlights the Cancer Research Institute’s role in working to bring effective immune-based cancer treatments to kidney cancer patients.
In its early stages, kidney cancer typically has no symptoms. As a tumor grows, symptoms may include blood in the urine, pain or a lump in the lower back or abdomen, fatigue, weight loss, and swelling in the ankles or legs. If kidney cancer is diagnosed while the cancer is still local (has not spread beyond the kidney), the 5-year survival rate is 92%. Often a tumor will be discovered when a patient has a CT scan or ultrasound for another reason. Like most cancers, kidney cancer is difficult to treat once it has spread to other parts of the body. Metastatic kidney cancer has a 5-year-survival rate of 12%.
Risk factors for kidney cancer include tobacco use, obesity, high blood pressure, chronic renal failure, exposure to certain industrial chemicals, such as trichloroethylene, and radiation.
Most renal cell carcinomas are a subtype called clear cell carcinoma. About 7 out of 10 people with renal cell carcinoma have this kind of cancer.
Surgery is the primary treatment for most kidney cancers. Many surgeries can be performed laparoscopically, i.e., through a minimally invasive surgical procedure. Ablation therapy using either heat or cold to destroy the tumor may be an option for patients who are not good candidates for surgery. Kidney cancer tends to be resistant to both chemotherapy and radiation therapy. Therefore, targeted therapies and immune-based treatments are important components of treatment for advanced kidney cancer.
Several targeted therapies have been approved by the FDA for use in advanced kidney cancer. These include drugs such as bevacizumab (Avastin) and sunitinib (Sutent), which stop the growth of the new blood vessels that nourish cancers; and temsirolimus (Torisel) and everolimus (Afinitor), which block a protein called mTOR. Targeted therapies are often the first line of treatment for advanced kidney cancer. One immunotherapy, the checkpoint inhibitor nivolumab (Opdivo), has been FDA approved to treat metastatic kidney cancer. Chemotherapy is generally used only after targeted therapies and immunotherapies have already been tried.
WHEN ARE CLINICAL TRIALS RECOMMENDED?
Currently available treatments for kidney cancer are less than optimal. Therefore, enrolling in a clinical trial is often the best and safest option for patients with kidney cancer.
For a complete list of open clinical trials for kidney cancer, see our Clinical Trial Finder.
IMMUNOTHERAPY FOR KIDNEY CANCER
The first suggestion that kidney cancer might be a good target for immunotherapy came from the observation that patients with metastatic kidney cancer occasionally experienced spontaneous regressions after surgical removal of the primary tumor[1]. Immunotherapies in the form of immune-stimulating chemicals called cytokines have been used for more than a decade to treat kidney cancer. The cytokines interleukin-2 (IL-2) and interferon-alpha cause kidney cancers to shrink in approximately 10%-20% of patients, and provide durable remissions in a subset of these patients. In the recent past, IL-2 was the most common first-line therapy for advanced kidney cancer, but because it can have serious side effects many doctors now only use it for cancers that are not responding to targeted therapies.
Beyond cytokines and targeted therapies, several newer immunotherapies are becoming important in the treatment of kidney cancer. They fall into six broad categories: checkpoint inhibitors and immune modulators, cancer vaccines, adoptive cell therapy, monoclonal antibodies, cytokines, and adjuvant immunotherapies. These therapies for kidney cancer are still in clinical testing, but their successful use in other types of cancers suggests that they may ultimately prove beneficial for kidney cancer patients as well.
Checkpoint Inhibitors
A promising avenue of clinical research in kidney cancer is the use of immune checkpoint inhibitors. These treatments work by targeting molecules that serve as checks and balances on immune responses. By blocking these inhibitory molecules or, alternatively, activating stimulatory molecules, these treatments are designed to unleash or enhance pre-existing anti-cancer immune responses. The following trials are currently recruiting patients:
Phase III
- A phase III study of nivolumab (Opdivo), a PD-1 antibody, with ipilimumab(Yervoy), a CTLA-4 antibody, versus sunitinib (Sutent), for patients with previously untreated advanced or metastatic renal cell carcinoma (NCT02231749).
- A phase III study of atezolizumab (MPDL3280A), a PD-L1 antibody, in combination with bevacizumab (Avastin) versus sunitinib (Sutent) in patients with untreated advanced renal cell carcinoma (NCT02420821).
Phase I/II
- A phase I/II study of atezolizumab (MPDL3280A), a PD-L1 antibody, andvarlilumab (CDX-1127), an anti-CD27 antibody, in patients with advanced cancer, including kidney cancer (NCT02543645).
- A phase I/II trial to test varlilumab (CDX-1127), an anti-CD27 antibody, in patients with metastatic clear cell kidney cancer (NCT02386111).
- A phase I/II study to test LAG525, an antibody that targets LAG-3, +/-PDR001, a PD-1 antibody, in patients with advanced cancer, including renal cancer (NCT02460224).
- A phase I/II study to test MBG453, an antibody that targets TIM-3, +/-PDR001, a PD-1 antibody, in patients with advanced cancer, including renal cancer (NCT02608268).
Phase I
- A phase I trial to test BMS-986016, a LAG-3 antibody, with or withoutnivolumab (anti-PD-1), in patients with solid tumors, including renal cell cancer (NCT01968109).
BRIEF STATISTICS
Approximately 62,700 new cases of kidney cancer will be diagnosed in the U.S. in 2016, including cancer of the renal pelvis and Wilms tumor, a childhood cancer. There will be approximately 14,240 deaths. Kidney cancer is more common in older people (>55 years old) and affects men more often than women.
Credit : Cancer Research Institute