Globally, kidney cancer is among the most common cancers. It is the 6th most common cancer in men and the 10th most common cancer in women, accounting for 5% and 3% of cancer cases, respectively. It causes about 140,000 deaths each year and is the 13th on the cancer mortality “list”. The incidence of kidney cancer in China is lower than in Europe and the United States, but in recent years, the incidence has shown a clear upward trend.
The annual meeting of the American Society of Clinical Oncology (ASCO), one of the most important meetings in the field of oncology. So let’s take a look at what new breakthroughs in the treatment of kidney cancer have been made at this year’s ASCO annual meeting.
Patients with operable kidney cancer
Navulizumab is better alone than in combination before kidney cancer surgery
For operable metastatic kidney cancer, doctors have been trying to treat it preoperatively to increase the success rate of surgical resection. So, is the currently hot PD-1 monoclonal antibody, navulizumab, better as a single agent or in combination when used preoperatively? A study at this year’s ASCO meeting provided the answer.
In the study, the following 3 treatments were given to patients with metastatic kidney cancer who were eligible for tumor-reducing surgery:
◆ Navulizumab monotherapy
◆ Navulizumab + bevacizumab (targeted anti-angiogenic agent)
◆ Navulizumab + ipilimumab (CTLA-4 monoclonal antibody, which is an immune checkpoint inhibitor)
After these 3 different treatments, the patient underwent surgery, and postoperative statistics revealed that the best overall response rates (complete remission + partial remission) corresponding to the 3 treatments were 55%, 44%, and 43%, respectively; median progression-free survival (PFS) times were 14.5, 7.6, and 7.5 months, respectively.
The data show that nabumetinumab alone is more effective than the combination in patients with operable metastatic kidney cancer, and the study shows that immunotherapy combined with tumor reduction is safe and can provide therapeutic benefit to patients with metastatic renal cell carcinoma.
After kidney cancer surgery, adjuvant therapy with targeted agents is not supported at this time
For operable metastatic kidney cancer, doctors have previously speculated that adding targeted drugs as adjuvant therapy after complete surgical removal of the metastases might be more effective. However, a study published at ASCO this year did not confirm this speculation.
In the study, in patients with kidney cancer with complete resection of metastases and postoperative use of the targeted drug pazopanib, patients did not have better recurrence-free survival than placebo, and overall survival time was even shorter than for patients on placebo.
The results of this study suggest that adjuvant therapy with targeted agents after surgery is not supported for resectable kidney cancer. More trials are needed to explore which types of drugs are appropriate for adjuvant therapy after kidney cancer surgery.
Inoperable metastatic kidney cancer
There is a new first-line treatment for advanced kidney cancer: pablizumab + axitinib[1]
Once kidney cancer metastasizes, patients have a very low survival rate, with a 5-year survival rate of 12%. In terms of treatment, there were few effective new drugs before. But that has changed. The results of a study presented at this ASCO (KEYNOTE-426) confirm that pabrolizumab, in combination with axitinib, is effective in extending survival in patients with metastatic kidney cancer.
Pabrolizumab is an immune drug that blocks PD-1 on the surface of immune cells, loosening the “brakes” on the immune system and boosting it to attack cancer cells. The two drugs are targeted to inhibit tumor angiogenesis, blocking the tumor’s “food supply”. The combination of these two drugs, which are both effective on their own in treating kidney cancer, has a 1+1>2 effect.
In the study, pablizumab in combination with axitinib as first-line therapy for metastatic kidney cancer significantly improved survival compared with the current standard of care (sunitinib), extending median progression-free survival by 4 months (15.1 months vs 11.1 months) and reducing the risk of death by 47%, with no significant increase in adverse events. More importantly, all patients in the study benefited from treatment with this regimen, regardless of PD-L1 expression and risk of progression of kidney cancer, with more benefit for patients at intermediate to high risk.
First-line treatment of advanced kidney cancer is no longer limited to targeted drug therapy alone, and physicians are increasingly applying immune combination targeted therapy. The combination of pablizumab in combination with axitinib has also been approved by the US Food and Drug Administration (FDA) for first-line treatment of advanced kidney cancer. With the release of the results of this study, it is once again confirmed that immune-combined targeted agents are superior to existing targeted therapies for first-line treatment of advanced kidney cancer, especially for intermediate to high-risk kidney cancer, and that targeted agents are still preferred for low-risk patients or for patients with kidney cancer such as simple lung metastases.