What’s New in Kidney Cancer Research and Treatment?

Research into the causes, detection, diagnosis, and treatment of kidney cancer is now being done at many medical centers, university hospitals, and other institutions across the nation.

Genetics

Scientists are studying several genes that seem to play a part in changing normal kidney cells into renal cell carcinoma (RCC).

For example, problems with the VHL tumor suppressor gene are found in most clear cell RCCs. This allows other genes such as the hypoxia-inducible factor (HIF) gene to be activated when they shouldn’t be, which drives a cell toward being cancerous. Some newer treatments focus on attacking this cellular pathway.

Researchers now also have a better idea of the gene changes responsible for some other forms of RCC. Doctors are trying to determine which treatments are most likely to be effective for certain types of RCC. This information can also be used to develop new treatments.

Targeted therapies

Because chemotherapy is not very effective against advanced kidney cancer, targeted therapies are now usually the first-line option to treat kidney cancers that cannot be removed by surgery or have spread outside the kidney. At this time they are usually given separately. Clinical trials are now under way to see if combining these drugs, either with each other or with other types of treatment, might be better than using them alone.

Neoadjuvant Therapy

The potential roles of giving targeted drugs before surgery (called neoadjuvant therapy) are also being studied. The hope with these studies is to shrink tumors to allow for less extensive surgery, prevent cancer spread and hopefully improve cure rates. This could also help people retain more of their normal kidney function.

Adjuvant Therapy

The potential roles of giving targeted drugs after surgery (called adjuvant therapy) are also being studied. The hope with these studies is to see if patients at high risk would benefit from taking certain targeted drugs after their kidney cancer surgery to reduce the chances of the cancer coming back.

Along with finding new medicines and looking at the best way to combine and sequence existing ones, a major area of research is finding better ways to choose the best treatment for each person. Researchers are looking for which factors might make a person's cancer more likely to respond to a certain medicine. This can increase the chances of being helped by a therapy and lower the chances a person will get a treatment that is unlikely to help them (and which could still have side effects).

Predicting Survival

Kidney cancer is typically unpredictable. Some cancers are very aggressive, while others can be very slow growing and last for many years. The way a tumor behaves depends on the specific type of kidney cancer it is. Given this, scientists are looking to see if they can more accurately predict how long someone with kidney cancer may live by testing the kidney cancer for specific traits. For example, one test checks how fast the cancer cells are dividing. Many factors of the cancer cell are looked at and a “score” is given to indicate how fast or slow the cells are growing. A lower score seems to match with a better outcome for the patient. More studies are being done in this area.

Immunotherapy

Kidney cancer seems to be one of the cancers most likely to respond to immunotherapy, which is treatment that boosts the body’s immune response against cancer cells. Clinical trials of many new immunotherapy methods are being tested. Basic research is now being directed toward a better understanding of the immune system, how to activate it, and how it reacts to cancer.