New Medicine Altering the Management of Renal Cell Carcinoma

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While the U.S. Food and Drug Administration’s approval of nivolumab for the treatment of metastatic renal cell carcinoma in November marked a milestone in RCC care, it was just one of several significant advances that have occurred over the past year.1 Advances in detecting and targeting genetic signatures are opening up new avenues of treatment along with new immunotherapies.

Many oncologists are encouraged by a growing body of scientific evidence showing that agents for treating other tumors may be beneficial in combating RCC. Richard Pazdur, MD, who is the director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research, announced the approval of nivolumab and noted that it is an extended indication.

It was already approved for treating melanoma and non-small cell lung cancer. He said the new approval for treating RCC demonstrates how immune therapies can benefit patients across a wide range of tumors. Nivolumab, which targets the cellular pathway PD-1/PD-L1, may be one of the several new agents changing the treatment paradigm in the coming months.

This summer, patients were enrolled in a novel immunotherapy trial involving AGS-003, an autologous dendritic-cell-based immunotherapy designed to induce a memory T-cell response specific to each patient’s unique tumor antigens, said Thomas Schwaab, MD, PhD, who is the principle investigator in the trial, as well as an associate professor of oncology in the departments of Urology and Immunology at Roswell Park Cancer Institute in Buffalo, NY. AGS-003 has shown promise in metastatic disease and is now being tested in localized disease. Schwaab said the goal is to develop a treatment that will interrupt tumor progression before it can metastasize.

“We don’t know how the immunotherapies will work yet. They are looking good for melanoma but I would caution that kidney cancer is different than other cancers,” Dr. Schwaab said in an interview with Cancer Therapy Advisor.

Dr. Puzanov agreed that there are several types of RCC that are only now being subtyped based on their genomic signatures.

Investigators at Rutgers Cancer Institute of New Jersey published a study in the journal Cell Reports that identified an entirely new way of identifying and potentially treating patients with kidney tumors.

2 The findings from this study suggest that inhibiting mitochondrial with agents such as metformin may have anti-cancer activity in a variety of cancers.

The investigators concluded that type-2 oncocytomas with chromosome loss may progress to the subtype of malignant kidney cancer known as eosinophilic chromophobe RCC. “There are no new modalities for localized RCC and surgery remains the best option with enrollment in an adjuvant clinical trial afterward. We are currently exploring everolimus versus placebo in an adjuvant trial run by the Eastern Cooperative Oncology Group and will soon open a trial with the anti PD-1 agent nivolumab for these patients,” Dr. Pazanov told Cancer Therapy Advisor.

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