Immunotherapy and Targeted Therapies in Advanced Kidney Cancer

Dr. Shirish S. Alurkar is a senior medical oncologist with a wealth of knowledge and experience. With almost four decades of experience, Dr. Alurkar is one of the most celebrated medical oncologists in the state of Gujarat, thanks to his expertise that extends across various facets of medical oncology. Dr. Alurkar is one of the first medical oncologists to start a private practice in Gujarat. He engages in a conversation with the India Pharma Outlook magazine to tell about immunotherapy and targeted therapies in advanced kidney cancer.

Our kidneys play a fundamental role in filtering the waste products of our body as well as maintaining the blood pressure. Kidney cancers account for 2-4 % of all cancers. Most cases are diagnosed late in India, resulting in high incidence of mortality and low survivals. The cancer cells arise in the tubules of the kidneys. The common symptoms or signs of a kidney cancer are painless blood in urine, pain in the abdomen or back, lump or mass in the abdomen, weight loss or anemia. The cancer can be detected by sonography, CT Scan or MRI of the abdomen. A biopsy of the mass confirms the presence and type of cancer. That biopsy results in spread of the cancer is a myth. A PET scan is essential for staging of the cancer.

A typical renal cell carcinoma spreads through the blood; but it can also spread by lymphatics to the neighbouring nodes.

Surgery is the mainstay of treatment in early stages and some advanced stages too. Usually the whole kidney is removed (total nephrectomy ) or a part is removed ( partial nephrectomy ). Radiation therapy has not much role except when the cancer has spread to the bones or spine.

The majority of advanced stages of renal cell carcinomas are treated by targeted therapies or immunotherapy or a combination of both. Targeted therapies consist of Tyrosine Kinase inhibitors ( TKI ) or anti-VEGF drugs. Most of these drugs (Sorafenib, pazopanib, sunitinib, cabozantinib, Lenvatinib, axitinib  )are given orally and hence very convenient for a patient. They are given continuously on a daily basis till the disease progresses further. However these oral drugs are not without side effects ; the common side effects are gastritis, fatigue, diarrhoea, vomiting, change of skin color, alterations in blood counts etc.

Immunotherapy has made a major impact in the treatment of advanced renal cell carcinomas. Basically, these drugs stimulate the ‘policeman cells’ or T-lymphocyte cells of the body , which attack the cancer cells and kill them. Recently Immunotherapy has been approved as adjuvant therapy ( post operative after removal of the kidney ). Common drugs used are Nivolumab, Pembrolizumab, Ipilimumab. Usually these are combined with TKIs like cabozantinib, axitinib and Lenvatinib. They are again recommended to be given till the disease progresses.

Immunotherapy drugs have side effects like fatigue, colitis, skin rash, pneumonitis, thyroid dysfunction and rarely effects on the brain. Immunotherapy drugs have radically changed the outcomes of patients with renal cancer ( better survival ) .