Update: On April 16, 2018, the FDA approved the combination of nivolumab and ipilimumab for the treatment of people with poor- and intermediate-risk advanced renal cell carcinoma. Show On March 21, 2018, new data from this study were published in the New England Journal of Medicine, further proving the efficacy of the ipilimumab and nivolumab combination. The trial included 1,096 total patients with metastatic renal cell carcinoma, and researchers found that overall survival favored the immunotherapy combination, with an 18-month overall survival rate of 78% compared with 68% with sunitinib alone. Original post: For years, oncologists had very few choices to treat patients with metastatic renal cell carcinoma. Their primary options were two types of immunotherapy drugs, interferon-alpha and interleukin-2, then the targeted therapy sunitinib (Sutent®), which was approved in 2006. Since then, sunitinib has remained the standard of care as initial treatment for this disease. People with metastatic renal cell carcinoma may soon have a new option to treat their disease and extend their life. On September 7, 2017, Bristol-Myers Squibb announced that the combination of the immunotherapies ipilimumab (Yervoy®) and nivolumab (Opdivo®) extended survival for people with metastatic renal cell carcinoma in a phase III trial. The study, led by MSK medical oncologist Robert Motzer, compared the combination of those immunotherapies against sunitinib alone in patients with the disease who had not yet received treatment. At the European Society for Medical Oncology (ESMO) Congress on September 10, 2017, oncologist Bernard Escudier of the Institut Gustave Roussy in France reported that the median overall survival for patients treated with sunitinib was 26.0 months while the median overall survival for those treated with the immunotherapy combination was not yet reached. Dr. Escudier was also an investigator on the study. “We have seen a significant improvement in overall survival,” Dr. Motzer said in an interview, with a caveat. “The data must continue to be looked at carefully to determine which patients will do better with ipilimumab and nivolumab and which might do better with sunitinib.” He said that there was a clear benefit for the combination among people with poor- and intermediate-risk renal cell carcinoma in extending overall survival and reducing tumor size. However, a small group of patients with favorable risk did see a higher rate of tumor shrinkage with sunitinib. Dr. Motzer highlighted the fact that the immunotherapy combination works completely differently from sunitinib and provides a better chance for longer survival for patients who have not yet been treated — what is known as first-line therapy, a crucial area of unmet need. “It’s a completely different mechanism of action and it introduces a new type of therapy in this setting,” Dr. Motzer says. “And with the exception of one trial many years back, we haven’t been able to demonstrate survival benefit in first-line therapy for renal cell carcinoma.” Because the drugs work differently, the side effects are different too, said Dr. Motzer. The possible side effects seen with immunotherapies are inflammation of the lungs as well as the bowel, which can lead to diarrhea; skin rashes; and more. “At MSK, we have extensive experience in treating patients with immunotherapies — with kidney cancer, melanoma, and beyond — and handling immune-related side effects,” he said. Dr. Motzer found it important to consider the larger context of this one trial. “This combination was initially developed here at MSK by [cancer immunologist] Jedd Wolchok in melanoma and it’s now the standard of care in that disease,” he said. “We’re following the same path in kidney cancer now.”
Immunotherapy is a process where certain medications are used to boost your immune system to increase its ability to fight off abnormal cells. This type of treatment has been used in cancer therapies, including those that help treat kidney cancer. Depending on your situation, your doctor may recommend immunotherapy as either a first-line or second-line treatment. However, it’s also important to know that some of these therapies pose serious side effects, and their effectiveness may be limited in advanced forms of kidney cancer. Read on to learn more about the types of immunotherapy available for kidney cancer and how effective they may be. The main types of immunotherapy used specifically for kidney cancer include:
Learn more about each type and the possible side effects of each below. CTLA-4 inhibitorsCTLA-4 inhibitors belong to a group of immunotherapy treatments called immune checkpoint inhibitors. Checkpoints are types of proteins on cells that help deliver immune responses. Immune checkpoint inhibitors ensure that all checkpoints are working to protect healthy cells against cancerous ones. Your doctor may recommend CTLA-4 inhibitors to help block proteins of the same name. These usually develop on T-cells. Ipilimumab (brand name Yervoy) is a CTLA-4 inhibitor used for kidney cancer. It may be used as a combination treatment with other immune checkpoint inhibitors. This therapy is delivered via intravenous (IV) infusions for up to four times total, with 3 weeks in between treatments. Side effects from CTLA-4 inhibitors may include:
PD-1 inhibitorsPD-1 is another type of immune checkpoint inhibitor that also targets T-cells. Two options include nivolumab (Opdivo) and pembrolizumab (Keytruda), which are both delivered via IV spaced weeks apart. PD-1 may help slow the growth of kidney cancer cells and expose tumor cells to immune system targeting and death, which may decrease tumor size. Side effects may include:
PD-L1 inhibitorsPD-L1 is a protein found in some cancer cells. By blocking this protein with PD-L1 inhibitors, the immune system may help shrink or stop further cancerous growths. Avelumab (Bavencio) is a type of PD-L1 inhibitor used for kidney cancer that’s also delivered though IV treatments. This medication is administered every 2 weeks and may be combined with other medications. Possible side effects include:
Interleukin-2 (IL-2) cytokinesIL-2 is a high-dose cancer treatment that’s administered via IV. Due to a high risk of side effects, it’s typically only used in advanced kidney cancer that hasn’t responded to other types of immunotherapy. Aldesleukin (Proleukin) is an example of a cytokine that targets the IL-2/IL-2R pathway. IL-2 is just one class of cytokines sometimes used to treat kidney cancer. Cytokines are types of proteins that may help boost the immune system, possibly shrinking or killing cancer cells and decreasing tumor size. Your doctor will consider whether you are in good enough health to tolerate the side effects. Such effects may include:
Interferon-alfa cytokinesInterferon-alfa is another type of cytokine treatment that may be an alternative to IL-2. The downside is that this treatment may not be effective in treating kidney cancer alone. In fact, your doctor may use it as part of a combination drug, which is injected under your skin three times per week. Side effects from interferon-alfa treatment may include:
Stages 1, 2, and 3 are considered early forms of kidney cancer. Most of these cases may be treated with surgery. If you have stage 4, or more advanced kidney cancer, your doctor may recommend immunotherapy. This type of treatment is also used in recurrent cancers. While the aforementioned immunotherapies may be used for stage 4 kidney cancer, there are some limitations and combination therapies that may be considered. These include:
Overall, researchers believe that immune checkpoint inhibitors —particularly PD-1 — may be helpful for advanced clear cell renal cell carcinoma (ccRCC). However, these inhibitors may produce the opposite effect in advanced kidney cancer. There are many different types of immunotherapy, so it’s difficult to give an estimate of the overall success rates for treatment. However, research has helped to reveal some trends that may improve treatment outlook. For example, combination therapies that use immunotherapy with a targeted therapy are thought to be more successful in treating advanced kidney cancer than using each treatment individually. Several studies have demonstrated that combining treatments can improve progression-free survival, the amount of time that patients go without their disease worsening. Many of these trials compare combination immunotherapy treatments to targeted therapy with a tyrosine kinase inhibitor (TKI) medication called sunitinib (Sutent), which discourages tumor growth. Sunitinib has been used as a first-line therapy for advanced kidney cancer since 2006. For example, a 2018 study found that combining nivolumab and ipilimumab led to a 75 percent survival rate at 18 months, compared with a 60 percent rate when using sunitinib alone. Of the 1,096 patients, the median progression-free survival was 11.6 months with the combination and 8.4 months with sunitinib. A 2019 study, funded by Pfizer, paired avelumab plus axitinib in comparison with sunitinib. Among the 866 patients, the median progression-free survival was 13.8 months with the combination therapy, as compared with 8.4 months with the single treatment. Another 2019 study, funded by Merck, combined pembrolizumab and axitinib in comparison with sunitinib. Among the 861 patients, the median progression-free survival was 15.1 months in the pembrolizumab/axitinib group and 11.1 months in the sunitinib group. IL-2 and interferon-alfa cytokines are thought to possibly shrink kidney cancer cells in only a small percentage of people. As such, cytokine treatment is reserved for cases where other immunotherapies don’t work. Due to the way they modify your immune system’s responses, checkpoint inhibitors may sometimes send your immune system into overdrive, leading to organ damage. Possible affected areas may include the:
To minimize side effects in these areas of the body, your doctor may prescribe oral corticosteroids. These immunosuppressants are sometimes used in place of traditional immunotherapy for kidney cancer if you don’t respond well to these types of therapies. Report any new side effects from immunotherapy to your doctor right away. You may also consider talking with them about complementary medical approaches to help manage existing side effects, such as:
Research in the areas of kidney cancer development, diagnosis, and treatment are ongoing. Recent clinical trials have also looked at the efficacy of immunotherapies for kidney cancer, along with the combinations with targeted drugs such as axitinib and cabozantinib. Once the safety of new treatments has been tested in a clinical setting, the FDA may approve future kidney cancer therapies. You may also consider talking with your doctor about the possibility of participating in clinical trials. The National Cancer Institute’s current list of clinical trials for kidney cancer treatment may be found here. Immunotherapy may treat kidney cancer by changing the way your immune system responds to cancerous cells. These come in the form of immune checkpoint inhibitors or cytokines. Sometimes, immunotherapy may be combined with targeted therapies for better outcomes in advanced cancer. Talk with your doctor about immunotherapy as a possible kidney cancer treatment option. You’ll also want to ask about the risk for side effects and complications. Can Stage 4 kidney cancer be cured with immunotherapy?While immunotherapy cannot cure cancer, several studies have shown that it can help a person live progression-free for longer. Doctors may recommend immunotherapy for people living with advanced stage IV or recurrent cases of kidney cancers.
Can immunotherapy cure renal cancer?Immunotherapy is the use of medicines to boost a person's own immune system to recognize and destroy cancer cells more effectively. Several types of immunotherapy can be used to treat kidney cancer.
How long can you live with immunotherapy kidney cancer?Among the 861 patients, the median progression-free survival was 15.1 months in the pembrolizumab/axitinib group and 11.1 months in the sunitinib group. IL-2 and interferon-alfa cytokines are thought to possibly shrink kidney cancer cells in only a small percentage of people .
Can metastatic cancer be cured by immunotherapy?An experimental form of immunotherapy that uses an individual's own tumor-fighting immune cells could potentially be used to treat people with metastatic breast cancer, according to results from an ongoing clinical trial led by researchers at the National Cancer Institute's (NCI) Center for Cancer Research, part of the ...
|
Immunotherapy in advanced renal cancer is cure possible
Copyright © 2024 en.frojeostern Inc.
