Immunotherapy for kidney cancer is now moving beyond cytokines and targeted therapies with several new checkpoint inhibitor options for treatment.
Kidney cancer—also called renal cell cancer—is more common in men than in women, and most frequently occurs in people over the age of 55. The kidneys, located on each side of the body toward the back of the abdominal cavity, filter blood, clear waste, and make urine. A person can live with only one functioning kidney.
About 9 out of every 10 kidney cancers are renal cell carcinomas—cancers that form in the lining of the tubules inside the kidney. About 7 out of 10 people with renal cell carcinoma have a subtype called clear cell carcinoma.
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. Often a tumor will be discovered when a patient has a CT scan or ultrasound for another reason.
Risk factors for kidney cancer include tobacco use, obesity, high blood pressure, chronic renal failure, and exposure to certain industrial chemicals, such as trichloroethylene, or radiation.
Globally, there are an estimated 400,000 cases of kidney cancer diagnosed each year along with 180,000 deaths. In the United States alone, there were an estimated 65,000 new cases and 15,000 deaths in 2018. If kidney cancer is diagnosed while the cancer is still local (has not spread beyond the kidney), the 5-year survival rate is 92%. 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%.
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Treatment for kidney cancer depends on individual factors, including exact location of the tumor, stage of the tumor, and the person’s general health. Conventional treatments for kidney cancer include surgery, laproscopy, and ablation.
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 determined by their physicians to not be 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. Chemotherapy is generally used only after targeted therapies and immunotherapies have already been tried.
Immunotherapy is class of treatments that take advantage of a person’s own immune system to help kill cancer cells. The first indication 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.
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.
There are currently four FDA-approved immunotherapy options for kidney cancer.
- Bevacizumab (Avastin®): a monoclonal antibody that targets the VEGF/VEGFR pathway and inhibits tumor blood vessel growth; approved for subsets of patients with advanced kidney cancer
Kidney cancer is one of the major cancer types for which immunotherapy treatments are being developed in preclinical studies and clinical trials.
Find a kidney cancer clinical trial
The Cancer Research Institute has supported the best scientists in the field working toward the improvement of kidney cancer treatment, including funding for research on IL-2 and interferon and newer treatment approaches using checkpoint blockades. CRI also funded a clinical trial of interferon-alpha in human patients in 1978, work that demonstrated kidney cancer's sensitivity to interferon—paving the way for treatment’s approval by the FDA.
- In 1993, based on promising laboratory findings, CRI provided financial support for a phase I clinical trial for patients with metastatic renal cell carcinoma, leading to the creation of GVAX, a therapeutic cancer vaccine.
- In 1999, CRI-funded researchers used SEREX technology in identifying tumor-related antigens in patients with renal cell carcinoma, providing a solid foundation for the theory that renal cancer could be immunogenic—recognizable by the human immune system.
- In 2010, several CRI researchers successfully completed a phase I study that showed a monoclonal antibody (PD-1 blockade) could induce frequent tumor regressions in renal cancer, among other cancer types, with low toxicity rates.
- In 2012, Jeffrey Rathmell, Ph.D., of Vanderbilt University, was awarded a Clinic and Laboratory Integration Program (CLIP) grant from CRI to study the metabolism of kidney cancer cells and the immune cells that surround them, discovering that anti-tumor T cells were found to be dependent on glucose and fail to function without it.
Explore CRI’s current support for kidney cancer research in our funding directory.
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