Second-Line Treatments for Metastatic Kidney Cancer

Metastatic renal cell carcinoma (RCC) has traditionally been treated with the second-line chemotherapeutic agent everolimus, but two other drugs have been newly identified as better options that can give months or even years of life to patients with metastatic RCC. Two studies led by Dr. Robert J. Motzer of Memorial Sloan Kettering Cancer Center have recently shown that nivolumab and cabozantinib each improve survival of patients compared to those receiving the traditional everolimus treatment. Nivolumab in particular shows great promise, with 25% of patients responding to the drug versus 5% with everolimus, and a median survival of 26 months compared to 19.6 for everolimus- such a dramatic difference that the study was stopped early to allow the patients on everolimus to switch to nivolumab.
Nivolumab belongs to a class of cancer drugs called immune checkpoint inhibitors that are designed to turn the patient’s immune system against the cancer cells. Normally, the immune system is able to recognize cells like cancer cells that are growing abnormally. The immune system is then able to send a signal to the cancer cells to self-destruct, blocking the progression of the cancer. As cancers progress, many develop ways of avoiding being spotted by the immune system, preventing the patient’s body from fighting off the cancer. Immune checkpoint inhibitors like nivolumab unmask the cancer cells and enable the immune system fight back again. This is the first time an immune checkpoint inhibitor has been shown to improve survival of patients with metastatic RCC and will likely result in the approval of nivolumab as a new second-line agent for treating this disease.
More information can be found at the New England Journal of Medicine or The New York Times.

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