Immunotherapy, given at an early stage immediately after surgery, is shown to significantly decrease the risk of the cancer coming back or having fatal consequences.
They reduce the risk of kidney cancer recurrence or death, which is responsible for 2-3% of adult cancers, by up to a third. And they are much better tolerated by the patient, who is no longer forced to live with the many temporary side effects typical of other drugs in use to date. These are the new immunotherapy drugs that are entering the therapeutic armamentarium of urological specialists, especially after robotic surgery, the treatment of choice for kidney cancer.
Six out of 10 cases discovered by chance
Immunotherapy with dembrolizumab is an important innovation in the post-surgical treatment of renal carcinoma, the form of cancer that has been diagnosed in over 144,000 Italians to date and which increases every year at the rate of 13,500 new cases. But there are other advances, as evidenced by the phase 3 study, Checkmate, in advanced renal cell carcinoma, where nivolumab in combination with cabozantinib brings important improvements in patients’ quality of life. Studies and new therapies on kidney cancer, called incidentaloma because it is randomly identified 60% of the time (by performing tests for other reasons), but when unfortunately it is late in a third of cases, they will be discussed by experts during the National Congress of the Italian Society of Urology (SIU) just consulsed Riccione. Its most common symptom is the appearance of blood in the urine, sometimes so modest that it can only be detected under a microscope – explains Vincenzo Mirone, professor of urology at the Federico II University of Naples and head of the SIU resources and communication office -. 55% of these carcinomas present at diagnosis limited to the kidney only, while in 30% of cases it has already developed metastases. And very difficult to identify. The treatment of choice is surgery, especially in consideration of the enormous progress made by robotics in recent years – adds Mirone -. Chemotherapy and radiotherapy, which have always been ineffective, are now rarely used. The new drugs The introduction of biological drugs and immunotherapies has revolutionized clinical practice. Today, the new drugs allow us to obtain two great results – explains Andrea Minervini, head of the research office of the SIU and director of the Department of minimally invasive oncological urology robotics and andrology of the Careggi University Hospital (Florence) -: for the first time immunotherapy, administered at an early stage, immediately after surgery, has been shown to significantly reduce the risk of kidney cancer recurrence, showing at the same time an absolutely favorable tolerability profile on the part of the patient. A recent phase 3 study KEYNOTE-564 evaluated pembrolizumab, anti-PD-1 therapy as a potential adjuvant treatment in patients with intermediate-high or high-risk renal cell carcinoma of relapse after nephrectomy (i.e. surgical removal of a kidney ) or after nephrectomy and resection of metastatic lesions. After 24 months, pembrolizumab demonstrated a 32% reduction in the risk of disease recurrence compared to placebo. A favorable overall survival trend was also observed, the definitive results of which are still being defined. It is interesting to note that in 7% of cases pembrolizumab was administered after renal conservative surgery (ie after only removal of the tumor disease, leaving the healthy portion of the kidney intact).
Conservative surgery
This study therefore opens the door to the possibility of adjuvant therapy to be performed even after partial nephrectomy in cases of more aggressive pathology.According to experts, then, the fact of being able to have new molecules, together with the advantages in terms of surgical precision and postoperative recovery ensured by robot-assisted surgery, they have allowed on the one hand to further extend the indication of renal conservative surgery also to more advanced renal tumors, and on the other hand to guarantee our patients better results both from an oncological and functional point of view. Among the new therapeutic strategies available in the treatment of advanced kidney cancer – concludes Minervini – there is also the use of nivolumab in combination with cabozantinib. According to a recent phase 3 study, Checkmate 9ER, in advanced renal cell carcinoma, approximately 33 months after treatment, this combination continues to show, compared to Sunitinib therapy, a superiority in overall survival (37.7 months vs. 34.3 months), progression-free survival (16.6 months vs. 8.3 months) objective response rate, duration of response and complete response.
October 21, 2022 (change October 21, 2022 | 16:53)
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