Immunotherapy is becoming an increasingly important treatment option for kidney cancer. While an old-fashioned, infrequently used immunotherapy, interleukin-2 (IL-2), has been approved since 1992, a more modern and more broadly applicable immunotherapy (e.g., PD1 inhibitors like nivolumab) has been approved for kidney cancer since November 2015.
Currently, immunotherapy is approved by the Food and Drug Administration (FDA) to treat kidney cancer patients only after they’ve tried more traditional therapies, such as targeted therapies killing the cancer’s blood supply.
We’re leading and participating in clinical trials to find out how well immunotherapy can shrink kidney cancer tumors when it’s given in combination with systemic drugs like targeted therapies or on its own by combining different types of immunotherapy drugs. The preliminary results are astonishing – we’ve found that immunotherapy can double the rate by which tumors shrink, and the effects can last for two years or longer.
How immunotherapy works for kidney cancer
Immunotherapy uses a patient’s immune system as a weapon to defend his or her body against cancer. The immune system has checkpoints which safeguards the body against an overly reactive and zealous immune response.
Cancer tricks the immune system by using these checkpoints to “turn off” the immune response and avoid being recognized or attacked by the immune system. This allows the cancer to grow and spread. During immunotherapy, we infuse the patient with antibodies, which are blood proteins that seek out and combine with immune system cells to take off the breaks (i.e., checkpoints) from the immune system and thus unleash its full force onto the cancer.
The FDA-approved drug nivolumab, or OPDIVO, has shown up to a 25 percent response rate for kidney cancer tumors, which means patients’ tumors shrink by 30 percent or more. This shrinkage lasts for around two years with often just mild side effects, if any.
Side effects of immunotherapy
The side effects of immunotherapy are usually quite different from those of traditional cancer drugs used in therapies such as chemotherapy. Traditional cancer treatments can cause hair loss, weight loss, diarrhea, loss of appetite, and a metallic taste in the mouth, among other side effects.
About one-third of immunotherapy patients experience mild autoimmune side effects, which occurs when the immune system attacks not only the tumor but also the patient’s body. The most common autoimmune side effects are a skin rash or mild fatigue. About 20 percent of these patients must take a steroid such as prednisone for four to six weeks until the side effects go away.
Rarely, immunotherapy will trigger a severe autoimmune response that can cause inflammation of the liver, lungs, or colon. That’s why it’s particularly important for kidney cancer patients to get their immunotherapy from a cancer center like ours. UT Southwestern specialists have the expertise to treat kidney cancer while at the same time safely and effectively managing the range of autoimmune side effects that may occur.
What to expect from kidney cancer immunotherapy treatment and trials
As of this writing, immunotherapy for kidney cancer has been approved for second-line kidney cancer treatment only. That means patients start on a traditional cancer treatment with pills inhibiting the cancer’s ability to make new blood vessels. If the first-line treatments don’t work, patients can transition to infusion immunotherapy. When people switch to infusion therapy, their appetites and energy often come back, and they usually regain weight and feel less fatigued.
The backbone of our clinical trial research is the infusion medication nivolumab or related drugs paired with other medications in varied combinations. We measure the effectiveness of these drug combinations based on the patients’ response rates. As mentioned, having a “response” means the tumor shrinks by 30 percent or more. A complete response is when the tumor goes away completely.
But the beauty of immunotherapy is that patients don’t have to have a complete response to feel the benefits of treatment. We’ve found through trials that a complete response is difficult to achieve, but patients whose tumors shrink by 30 percent can experience a major increase in quality of life. Many patients’ cancers stop growing for a number of years, allowing them to go off treatment completely for a period of time. And a small number of patients might never have to have therapy again. For these patients, we actively monitor their disease to be sure we’re ready if the cancer grows again.
One of the goals of our kidney cancer team is to lead the development of immunotherapy as a prominent treatment for kidney cancer. We offer a large portfolio of immunotherapy trials that simply aren’t available anywhere else in the region.
If you or a loved one is diagnosed with kidney cancer, don’t give up hope. There are options such as immunotherapy that can substantially improve quality of life and potentially cure the cancer. Request an appointment to discuss immunotherapy with an oncologist.