Can immune checkpoint inhibitors be used for kidney cancer patients?

by Specialist

Lately, immunotherapy, represented by a large class of drugs called “immune checkpoint inhibitors,” has become a big hit. So, can they be used by kidney cancer patients?

In fact, long before the advent of “immune checkpoint inhibitors,” doctors used “traditional” immunotherapy – interleukin-2, interferon-alpha, and other drugs – to treat kidney cancer. However, their efficacy varied greatly among patients and side effects were serious, so they were not commonly used. The “immune checkpoint inhibitors” can precisely block the interference of cancer cells with the body’s immunity, and re-energize the tumor-killing effect of immune cells, which is effective for kidney cancer.

Here’s a look at some of the immune drugs that can be used for kidney cancer. How effective are they?

What are the immune checkpoint inhibitors that can be used for kidney cancer?

There are two immune checkpoint inhibitors currently approved for use in kidney cancer in the United States:

  • Navulizumab (trade name: Ondivolol, which is in the PD-1 monoclonal antibody class)

  • Ipilimumab (trade name: Yervoy, which belongs to the CTLA-4 monoclonal antibody class)

In addition, Atezolizumab (trade name: Tecentriq, which belongs to the PD-L1 monoclonal antibody class) is not yet approved for kidney cancer, but there are studies that confirm its efficacy over current first-line therapy (sunitinib).

Unfortunately, nabolutumab is not approved for kidney cancer, although it is available in China, and neither Ipilimumab nor Atezolizumab is available in China.

Other immune checkpoint inhibitors for kidney cancer are being studied, and when successful, will lead to more options.

What’s so great about immune checkpoint inhibitors?

What conditions can these drugs be used for? How do they work? How effective are they? Is it safe? We’ve used the table below to help you sort it out.

The objective remission rate, often referred to in the table, is a technical term that refers to the proportion of all patients on medication whose tumors shrink to a certain extent and are maintained for a certain period of time, and is often used as an indicator of the efficacy of oncology treatment.

Table 1. Indications and efficacy of immunotherapy regimens for kidney cancer

Program Applications Efficacy
Navulizumab monotherapy Second-line therapy

  • Objective remission rate of 25% and overall survival of up to 25 months.

  • Objective remission rates were nearly 5-fold higher, overall survival was 5 months longer, and safety was better compared to everolimus as the standard of care.

  • And overall survival was better with second-line treatment with navulizumab than with everolimus, regardless of the patient’s prior treatment regimen.

Navulizumab in combination with Ipilimumab

First-line treatment of intermediate- and high-risk patients with advanced disease

  • The objective remission rate was 42%, with 9% of patients having complete tumor disappearance and half of patients maintaining stable disease for more than 11.6 months, significantly better than standard therapy (sunitinib).

Atezolizumab in combination with bevacizumab First-line therapy

  • Objective remission rate of 43%, with half of patients maintaining stable disease for more than 11.2 months, significantly better than sunitinib

The table says that nabumab in combination with Ipilimumab is only for “intermediate-high risk” patients. So, who are the “intermediate-high risk” patients? According to the commonly used criteria (IMDC criteria), patients are at intermediate to high risk if they meet any 1 of the following 6 criteria:

1) <1 year from diagnosis of kidney cancer to initiation of systemic therapy;

②Poor physical status [professionally assessed by the Karnofsky score, with a score of <80% being poor physical fitness];

③ Below normal hemoglobin;

④ A higher than normal platelet count;

⑤ Neutrophil count higher than normal;

⑥Corrected blood calcium concentration>10 mg/dL.

For “low-risk” patients who do not meet any of these criteria, the current evidence does not support the use of the nabritumomab+Ipilimumab regimen; sunitinib is better.