Kidney Cancer

The phase 2 LITESPARK-003 study explored belzutifan plus cabozantinib in patients with locally advanced or metastatic clear cell renal cell carcinoma.

At 5-year follow-up, overall survival among patients with kidney cancer who had quit smoking was 85% compared with 61% for those that continued to smoke.

The phase 2 CaboPoint trial is exploring cabozantinib in patients with locally advanced or metastatic renal cell carcinoma who progressed after first-line checkpoint inhibitor–based combination therapy.

“These disparities are concerning as the generalizability of clinical trial results relies on the assumption that the population of patients included in a clinical trial represents the overall population of patients with the disease," says Brian M. Shinder, MD.

The median overall survival in renal cell carcinoma patients was similar, regardless of whether or not patients received a break from treatment.

“Now in 2023, it’s really a question of how to apply these agents and which combinations to use in the first line,” said Vincent (Wenxin) Xu, MD.

“As a whole, the benefits of the lenvatinib plus pembrolizumab combination proved to be durable, statistically significant, and clinically meaningful,” said senior author Camillo Porta, MD.

“Same-day discharge after partial nephrectomy in properly selected patients is safe and cost effective for both patients and the health system,” says Andrew Wood, MD.

Published results from the phase 3 CONCEPT study showed improved outcomes with the combination compared with either agent alone.

“I am seeing this process rapidly expand, particularly with the use of the single-port robot, which offers additional benefits to things like pain control and helps to further expedite early discharge,” Andrew Wood, MD.

The patient presented with a large right renal mass who elected for right radical nephrectomy with possible inferior vena cava.

“First and foremost is that same-day discharge appears to be safe. There were no failure-to-rescue events within 24 to 48 hours after discharge outside of the hospital,” says Andrew Wood, MD.

The phase 2 Cyto-KIK study is exploring cytoreductive surgery plus immunotherapy with nivolumab and targeted kinase inhibition with cabozantinib in metastatic kidney cancer.

“As other factors such as access to care, socioeconomic conditions, patient preference, and other unknown confounders might have played a role in the observed disparity, it is still unclear whether overestimating the postoperative eGFR of Black patients contributes to the lower use of nephron-sparing approaches in this population,” the authors write.

"Augmented biopsy-based and noninvasive options are available to reduce benign resection rates of renal tumors with the consideration of PEER and 99mTc-sestamibi SPECT/CT," writes Hiten D. Patel, MD, MPH.

As the year comes to a close, we revisit some of this year’s top content on kidney cancer.

“Ultimately it really does come down to the discussion with the patient,” says Bradley McGregor, MD.

The FDA’s Fast Track Designation is designed to expedite the review and development of novel treatments that will fill an unmet medical need.

“The biggest question that arose from this is, ‘Why is there such a lack of large familial genetic disorder epidemiological studies?’ says Laura Bukavina, MD, MPH.

“We need to continue to push the field forward, and the way we do that is to evaluate the risk factors and to stratify patients based on their risk factors and their genetic components,” says Laura Bukavina, MD, MPH.

"What was surprising to me is that the incidence [of kidney cancer] has leveled off over the past 2 years," says Laura Bukavina, MD, MPH.

“Due to the rarity and poor molecular characterization of nccRCC, there is an underrepresentation in clinical trials evaluating patients with this type of RCC; because of this, patients are often treated with non-tailored therapies,” the researchers wrote.

Findings shared during the 2022 International Kidney Cancer Symposium showed that patients with advanced renal cell carcinoma treated upfront with pembrolizumab plus lenvatinib were far less likely to need second-line therapy vs patients receiving first-line sunitinib.

The updated results were shared at the 2022 International Kidney Cancer Symposium.

“The association between CKD and end-stage renal failure and increasing risk of kidney cancer is a really striking and important association to be aware of,” says Sarah P. Psutka, MD, MS.

"Up-front CN is associated with a survival benefit in selected patients with mRCC treated with either targeted therapy or ICI therapy," writes Badar M. Mian, MD.

“We really need to understand patient selection and treatment sequencing,” says Rana McKay, MD.

Rana McKay, MD, says that given the frontline shift from anti-VEGF monotherapy to immunotherapy doublets for advanced renal cell carcinoma, many of the studies informing the second-line setting have become “somewhat antiquated.”

Rana McKay, MD, says the CheckMate-214, KEYNOTE-426, CheckMate-9ER, and CLEAR trials have revolutionized the first-line treatment paradigm in advanced renal cell carcinoma.

“There has never been a clinical trial for these patients. It is unclear whether these patients should be treated with medication, surgery, or another approach. This represents an unmet medical need,” said Raquibul Hannan, MD, PhD.