What’s New in Kidney Cancer Research?

Research into the causes, detection, diagnosis, and treatment of kidney cancer (renal cell carcinoma, or RCC) is being done at many medical centers, university hospitals, and other institutions around the world. A few examples of these are discussed here.

Genetics of kidney cancer

Researchers are learning more about the gene changes inside kidney cells that cause them to become cancer cells. Knowing about these changes has helped doctors better classify kidney cancers into different types, which can sometimes affect treatment choices. This information has also helped researchers develop newer drugs that specifically target some of these changes inside the cancer cells (see below).

Local forms of treatment

Many kidney cancers can be treated by removing or destroying the tumor(s). Treatments such as surgery, ablative treatments, and radiation therapy can be helpful in different situations. Doctors are developing newer approaches to these treatments. For example:

Surgery to remove kidney cancer can now often be done using robotic-assisted laparoscopic surgery, in which the surgeon sits at a panel in the operating room and controls very precise robotic arms to do the surgery.

Newer types of ablative treatments, such as microwave ablation and irreversible electroporation, are now being studied for use in destroying tumors in the kidneys or other parts of the body.

Newer forms of radiation therapy, such as stereotactic body radiation therapy (SBRT), are now an option to treat some tumors.

Treatment options for advanced non-clear cell renal cell carcinoma

The most common type of kidney cancer is clear cell RCC. A small portion of kidney cancers, called non-clear cell RCCs, are different subtypes, which might respond better to different types of treatment than those used for clear cell RCC. Doctors are now studying which treatments might be most helpful for these cancers.

Targeted therapy and immunotherapy

In the last couple of decades, newer types of drug treatments have emerged as the most effective treatment options for most advanced kidney cancers.

Targeted drugs attack specific parts of cancer cells (or nearby cells that help them grow, such as the cells that make new tumor blood vessels).

Immunotherapy drugs help the body’s own immune system find and attack the cancer cells.

These types of drugs, alone or combined, are now usually the main treatment options for kidney cancers that can’t be removed completely with surgery. Doctors are now studying which combinations of drugs might work best.

Newer types of targeted and immunotherapy drugs are being developed. For example, CAR T-cells are a person’s own immune cells that have been altered in a lab to attack a target on cancer cells. Researchers are now looking to see if CAR T-cells designed to attach to the CD70 protein on cancer cells can be helpful in treating advanced RCC.

Adjuvant therapy

Doctors are studying if giving additional (adjuvant) treatment after surgery can help lower the risk of kidney cancer coming back, especially when there’s a higher risk this might happen. For example, getting the immunotherapy drug pembrolizumab (Keytruda) for about a year has been shown to help lower this risk in some people, especially those with clear cell RCC. Other medicines are being studied as well to see if they can lower this risk.

Neoadjuvant therapy

Doctors are also studying giving drug treatments such as immunotherapy or targeted therapy before surgery (called neoadjuvant therapy).

• For some people whose cancer can be removed, it might shrink the tumor(s). This might let the doctor do a less extensive surgery, and it might help lower the risk that the cancer will come back.
• For some people whose tumors can’t be removed completely with surgery,  it might shrink the tumor enough that surgery can be done.

Studies are being done to see which people might benefit the most from neoadjuvant therapy (as well as which drugs might be most effective in this setting).

Tests and other factors to help determine treatment options

Along with looking for new medicines and the best ways to combine and use existing ones, a major area of research is finding better ways to choose the best treatment for each person.

Researchers are looking at whether certain lab test results or other factors might make a person's cancer more (or less) likely to respond to certain medicines. Knowing this can help doctors give treatments that are more likely to be helpful, while avoiding giving those that aren’t (but that could still have side effects).