March 10, 2016 | by Sumanta Kumar Pal, M.D.
Kidney cancer is a rare disease, representing just 3 percent of all cancers. Having said that, it has been perhaps one of the most rapidly growing areas of oncology.
This has not always been the case — if you look back to the years from 1992 to roughly 2005, there were no new drugs approved for the disease. However, over the past decade, from 2005 onward, there has been a veritable explosion of new treatments available.
I’ve listed here five of the big highlights that we should all keep an eye out for this year in kidney cancer research and treatment:
1. New data for cabozantinib
Cabozantinib is a unique drug that distinguishes itself from all of the existing drugs for kidney cancer. It is a targeted drug, meaning that it blocks certain proteins that drive kidney cancer growth. In this respect, it is not unique. However, cabozantinib appears to work where other drugs in kidney cancer fail. It achieved what one might term a trifecta in terms of benefits to patients by improving overall survival, by delaying cancer growth and by generating a higher response rate than its competitor.
The drug will be considered for regulatory approval later this year.
2. Nivolumab for renal cell carcinoma
Nivolumab is an immune-stimulating agent. You may be familiar with the drug from its role in more common diseases such as lung cancer. In kidney cancer, nivolumab demonstrated an improvement in both overall survival and response rate relative to traditional comparators in this setting.
The drug works by an incredibly unique mechanism: by stimulating the patient’s own immune response against cancer. It does so with a very mild side effect profile, which is a tremendous benefit to my patients with advanced disease.
3. Combination therapies
For the longest time, there was a suspicion that combining different treatments for advanced kidney cancer, i.e. different targeted agents, would result in clinical benefit. However, this hasn’t panned out in the majority of phase 1 and phase 2 clinical trials that have been done to date. Many combinations of targeted agents have demonstrated either very poor safety profiles or have shown little benefit over using agents independent of one another as single drug therapies.
However, this may all be changing. A combination of lenvatinib with everolimus demonstrated a significant improvement in progression-free survival, or delay in cancer growth, over using one targeted agent alone. Interestingly, this particular drug may be considered for regulatory approval in short course. This is an unusual paradigm because, to date, most of the agents approved for kidney cancer have required phase 3 clinical trials.
The signal here is strong, but keep in mind that the regulatory approval for this combination is being considered on the basis of a phase 2 study.
4. Understand the genomics of rare kidney cancer
Kidney cancer itself is a rare disease. It’s oftentimes easy to think of it as being one single entity. But in fact, there are multiple subtypes of kidney cancer and one of the benefits of working at a large tertiary care center like City of Hope is that we have a large research experience across many of the rare subtypes of the disease.
I have worked aggressively to characterize the genomic profile of many of these rare subtypes. We had an important manuscript published in the journal of European Urology last year, which looked at a rare subtype termed "collecting duct" kidney cancer.
Collecting duct represents just 1 percent of all kidney cancers and tends to affect very young patients, often in their late teenage years or early twenties. Through better understanding the genes that drive the diseases, we come one step closer to identifying treatments.
5. Understanding the microbiome in patients with kidney cancer
We are learning more and more across multiple diseases that the bacteria that populate our intestinal tract may potentially play a role in our response to various drugs. City of Hope is the first to characterize the relationship between intestinal bacteria and the presence of diarrhea with various agents of kidney cancer.
We are embarking on some very novel projects right now to determine whether or not bacteria within the gut can potentially be related to responsiveness to immune-based treatments for kidney cancer.
So in summary, expect major developments in 2016, and many more to come over the next several years. We are entering into a phase of rapid growth in the diagnosis and treatment of kidney cancer. We are certainly eager to continue the robust pace of research conducted here at City of Hope to ensure that development in this area continues at breakneck speed.
Learn more about City of Hope's Kidney Cancer Program and research and Sumanta Kumar Pal, M.D. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.