Kidney Cancer

Immunotherapy has expanded the landscape of treating advanced renal cell carcinoma (RCC), the most common form of kidney cancer. In certain situations, it has become standard of care as first-line therapy for ad- vanced RCC. Recently, the U.S. Food and Drug Administration (FDA) has approved several combination immunotherapy treatments. These medications are given intrave- nously (IV) through a needle inserted into a vein in your arm and are considered systemic, meaning they travel throughout your body.

Immune Checkpoint Inhibitors

More options for treating kidney cancer are now available due to the approval of immune checkpoint inhibitors. In many cases, this class of immunotherapy is standard of care for advanced RCC, and some immune checkpoint inhibitors are also considered first-line therapy. The inhibitors currently approved block PD-1, PD-L1 or CTLA-4. The FDA has also approved multiple immune checkpoint inhibitor combinations for advanced and metastatic RCC. Combinations with some targeted therapies have also been approved.

You may qualify for first-line treatment with some of the immune checkpoint inhibitors if you have advanced RCC or are classified as intermediate or poor-risk and haven’t had previous treatment.

This class may also be used as second-line therapy for advanced RCC if you previously received antiangiogenic targeted therapy or your tumors test positive for microsatellite instability-high (MSI-H) or mismatch re- pair deficiency (dMMR), and your tumors progressed after previous treatment and you have few alternative options.

Nonspecific Immune Stimulation

Two cytokines, a type of nonspecific immune stimulator, were the first type of immuno- therapy approved for RCC: interleukins and interferons. They are not as widely used today as immune checkpoint inhibitors.

A type of interferon is still occasionally used in combination with a targeted therapy for metastatic RCC. Researchers in clinical trials are testing if cytokines make a good combination with immune checkpoint in- hibitors. But immune checkpoint inhibitors and targeted therapy options have largely replaced the use of interferon.

High-dose interleukin was one of the first immunotherapies approved to treat meta- static RCC. It offered a longer duration of complete remission, but patients are now carefully selected for this treatment because of the high level of side effects.

Clinical Trials

Immunotherapy for RCC is a large focus in clinical trials. Researchers are studying cancer vaccines to treat kidney cancer and prevent a recurrence with advanced RCC. Modified cytokines are also an area of research. The goal is to create an effective treatment with fewer serious side effects. With the increased use of immune checkpoint inhibitors, studies are ongoing to find more that are effective in kidney cancer. Ask your doctor if you are a candidate for a clinical trial.