Promising New Kidney Cancer Treatments Are Improving Survival

A revolutionary shift in the treatment of kidney cancer in the past decade has turned a once devastating diagnosis into a scenario of growing hope and possibility. Physicians at Baptist Health Miami Cancer Institute are on the cutting edge of innovation, helping to develop targeted therapies, immunotherapies and precision medicine techniques —as well as using sophisticated imaging technology that makes early diagnosis more likely. Their concerted efforts are improving outcomes.

“Today, about 40 percent of patients with stage 4 kidney cancer live beyond five years,” says Rohan Garje, M.D., chief of genitourinary medical oncology at the Institute. “Before we had immune checkpoint inhibitors, the survival rate was between 18 months and two years.” Some 93 percent of patients with stage 1 disease live beyond five years.

Kidney Cancer Risk Factors

March is Kidney Cancer Awareness Month. In 2024, nearly 82,000 cases of kidney cancer were expected to be diagnosed in the U.S., according to the American Cancer Society. A disease that is twice as common in men than in women, kidney cancer is predominantly diagnosed between the ages of 55 and 74. It affects more African Americans, American Indians and Alaska Natives than people of other ethnic groups.

Other risk factors for kidney cancer include tobacco use, obesity, high blood pressure, kidney disease, chemical exposure and some genetic conditions such as familial renal cancer and Von Hippel-Lindau (VHP) disease. There is no screening that is broadly recommended, and while most patients are asymptomatic, some have signs such as blood in the urine, pain in the flank or back, unexplained weight loss and fatigue.

Detecting Kidney Cancer Early

Often, kidney cancer is detected when a patient receives a CT scan or ultrasound for another health problem, Dr. Garje says. Several newer tests are beginning to be used when kidney cancer is suspected, including a CA9 PET scan. It can help physicians locate and monitor tumors by using a small amount of a radioactive tracer to detect carbonic anhydrase IX (CA9), a protein often expressed in high amounts in certain types of cancer, particularly in tumors that are low in oxygen.

A biomarker called Kidney Injury Molecule-1 (KIM-1) is being developed as a blood test, as a promising biomarker for predicting renal cell carcinoma (RCC) disease recurrence after surgery. KIM-1 is a protein that is found in very low levels in healthy people but is produced in much more significant amounts when the kidneys are injured or stressed.

“Beyond identifying cancer earlier, we are trying to see if we can use biomarkers to help us stratify or determine if a particular patient will benefit from a specific agent or drug. We are in a new age when it comes to both detecting kidney cancer and treating it,” Dr. Garje says.

The Growing Role of Immunotherapy and Immune Checkpoint Inhibitors

Treatment may include surgery to remove the kidney or part of the kidney. Some patients, however, are not good surgical candidates due to frail health, the location of their tumor or the advanced nature of the cancer. Chemotherapy, while effective against many cancers, is usually less effective for kidney cancer, except in the case of the rare and aggressive variant called renal medullary carcinoma.

Immunotherapy uses medications to help the body’s own immune system recognize and attack cancer cells. Normally, immune cells have molecular “checkpoints” that prevent them from attacking healthy cells, but cancer cells often create a cloaking system to help them avoid detection by the immune system. Checkpoint inhibitors, a type of immunotherapy, help remove the cancer’s camouflage. These drugs include pembrolizumab and nivolumab, and doctors often use them in combination with other agents to more effectively fight tumors.

Clinical Trials for Kidney Cancer

Physicians at Miami Cancer Institute are involved in numerous kidney cancer clinical trials. Among them are:

·      The ARC-20 trial, which is evaluating a novel Hypoxia-Inducible Factor (HIF) inhibitor. HIF inhibitors help block the growth of abnormal cells, slowing or stopping the growth of tumors. The study is currently enrolling patients with advanced kidney cancer.

·      The SAMURAI study (Testing the Addition of Stereotactic Radiation Therapy with Immune Therapy for the Treatment of Patients with Unresectable or Metastatic Renal Cell Cancer). Opening soon, it is a Phase 2 multi-institutional trial for patients with renal cell cancer who are not recommended for surgery and whose cancer has spread to other parts of the body. SAMURAI is studying whether radiation to the primary tumor, using stereotactic ablative radiation therapy, a highly focused radiation treatment with an intense dose of radiation to shrink tumors with precision, in addition to immunotherapy, the standard of care, will shrink or stabilize the cancer.

While physician-scientists hope that their research will lead to a breakthrough in cancer treatment, they are also enthusiastic about developing and fine-tuning medications that are better tolerated and still effective. “Some patients experience serious complications from their medications, so we are always looking to reduce side effects, whether that’s by creating novel agents or using them in various combinations,” Dr. Garje says.

In-roads in treating kidney cancer are also coming with advances in genetic testing and a better understanding of the molecular make-up of tumors. By analyzing the genetic profiles of tumors, doctors can now identify mutations that make certain tumors more susceptible to specific treatments, such as targeted therapies and immunotherapies. This information leads to a more personalized approach to care.

“Progress comes with research,” Dr. Garje says. “In more rare cancers, it can be challenging to have a clinical trial because you don’t have many patients. But we are beginning to see much more collaboration, pooling our data with cancer centers around the world, for example. Together, we can make more headway in the fight against common and uncommon cancers.”

Rohan Garje, M.D., chief of genitourinary medical oncology at Baptist Health Miami Cancer Institute

If you have kidney cancer, Dr. Garje recommends getting treatment from an experienced, multidisciplinary center such as Miami Cancer Institute.