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Immunotherapy For Kidney Cancer: A Urologist’s Guide

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Understanding Kidney Cancer and Immunotherapy

Kidney cancer, medically referred to as renal cancer, is a disease where kidney cells become malignant and grow uncontrollably, forming a tumour. The most common type is renal cell carcinoma (RCC), which originates in the lining of the small tubes within the kidney. Kidney cancer typically affects adults, with its incidence increasing with age. Immunotherapy is a type of cancer treatment that utilizes the body’s immune system to fight cancer cells. Unlike traditional treatments like chemotherapy and radiation therapy, which target cancer cells directly, immunotherapy works by enhancing or restoring the immune system’s natural ability to detect and destroy cancer cells.

Types of Immunotherapy for Kidney Cancer

Immunotherapy for kidney cancer involves several types of treatments, each with a unique mechanism of action. The choice of treatment depends on factors including the stage of cancer, the overall health of the patient, and previous treatments administered.

Immune Checkpoint Inhibitors

These drugs work by blocking proteins that prevent immune cells from attacking the cancer cells. Common checkpoint inhibitors used in kidney cancer include nivolumab (Opdivo) and pembrolizumab (Keytruda). These inhibitors target PD-1 or PD-L1 proteins, releasing the ‘brakes’ on the immune system and allowing it to attack cancer cells more effectively.

Cytokine Therapy

Cytokines are substances produced by the body’s immune cells that can enhance the immune system’s ability to fight cancer. Interleukin-2 (IL-2) and interferon-alpha are examples of cytokines used in the treatment of kidney cancer. They help in boosting the immune system’s response against cancer cells.

Cancer Vaccines

Although not as commonly used or as widely available as other forms of immunotherapy, cancer vaccines could also be considered. These vaccines aim to prompt the immune system to recognize and attack kidney cancer cells.

Combination Therapies

Combining immunotherapy drugs with other cancer treatments, such as targeted therapy, could enhance the effectiveness of the immune response against cancer cells.

Eligibility for Immunotherapy

Determining eligibility for immunotherapy in kidney cancer patients involves a thorough assessment of several factors:

  • Cancer Stage and Type: Immunotherapy is considered for advanced or metastatic renal cell carcinoma. It may not be the first line of treatment for early-stage kidney cancer, where surgical options are often more effective.
  • Overall Health and Medical History: The patient’s overall health should be considered, including their organ functions and immune system status. A comprehensive medical history, including any autoimmune diseases or other conditions that might affect the immune system, is evaluated.
  • Previous Cancer Treatments: The types of treatments the patient has received in the past, including surgeries, chemotherapy, or radiation therapy, can influence the effectiveness and choice of immunotherapy.
  • Biomarkers: The presence of certain biomarkers can indicate whether a patient is likely to respond well to immunotherapy. For example, a high level of PD-L1 expression in tumour cells may suggest a better response to PD-1 or PD-L1 inhibitors.

Benefits of Immunotherapy

Immunotherapy has brought benefits to the treatment of kidney cancer, particularly in cases where traditional therapies have had limited success.

Enhanced Survival Rates

Several immunotherapy treatments have been shown to extend the overall survival rates for patients with advanced kidney cancer. This is an improvement compared to historical outcomes with conventional treatments.

Targeted Treatment

Immunotherapy offers a more targeted approach compared to traditional therapies like chemotherapy. By focusing on boosting the body’s natural immune response, these treatments can more effectively target and destroy cancer cells.

Potential for Long-Term Control

Some patients treated with immunotherapy experience long-term remission. This extended control over the disease is a shift from the often temporary responses seen with other treatments.

Reduced Toxicity

While immunotherapy can have side effects, they are generally less severe than those associated with chemotherapy or radiation therapy. This can lead to an improved quality of life during treatment.

Applicability in Various Stages

Immunotherapy has shown effectiveness in various stages of kidney cancer, including as a first-line treatment for advanced or metastatic cases.

Synergy with Other Treatments

Immunotherapy can be combined with other cancer treatments, such as targeted therapies, to enhance overall effectiveness.

Potential Side Effects and Management Strategies

Like all medical interventions, immunotherapy is not without potential side effects. This is due to the immune system becoming overly active and attacking normal tissues as well as cancer cells. Common side effects that patients may experience include fatigue, skin reactions, fever, cough, nausea, and loss of appetite. More serious but less common side effects include inflammation of the lungs, intestines, liver, or other organs. There is also a risk of autoimmune reactions, where the body’s immune system attacks its tissues. Early detection and management of side effects can help mitigate these effects. This often involves working closely with your doctor to monitor for symptoms and to adjust treatments as necessary. In some cases, corticosteroids or other immunosuppressive drugs can be prescribed to reduce inflammation and manage autoimmune responses. If severe side effects occur, the treatment plan may be modified, including changing the type or dosage of immunotherapy or temporarily stopping treatment.

Comparing Immunotherapy to Other Kidney Cancer Treatments

Immunotherapy vs Chemotherapy

Traditional chemotherapy works by killing rapidly dividing cells, both cancerous and normal, leading to a range of side effects. Immunotherapy, in contrast, specifically targets the immune system to attack cancer cells, often resulting in fewer and less severe side effects.

Immunotherapy vs Radiation Therapy

Radiation therapy targets specific areas of the body to destroy cancer cells with high-energy rays. Immunotherapy works systemically, enhancing the body’s immune response against cancer cells throughout the body.

Immunotherapy vs Targeted Therapy

Targeted therapies act on specific molecular targets associated with cancer. Immunotherapy stimulates or modulates the immune system as a whole. The two can be complementary, and combination therapies are becoming increasingly common in treating kidney cancer.

Immunotherapy vs Surgery

Surgery is often the primary treatment for early-stage kidney cancer. Immunotherapy is generally used in more advanced stages or when the cancer has metastasized, where surgery alone is insufficient.

Response Rates and Durability

Immunotherapy may offer longer-lasting cancer control in some patients, particularly those with advanced disease, compared to traditional treatments.

Personalization of Treatment

Immunotherapy allows for more personalized treatment approaches, considering the unique immunological makeup of each patient and their cancer.

Conclusion

Immunotherapy has transformed the treatment landscape for kidney cancer, particularly in advanced stages. It provides improved efficacy and a more personalised approach compared to traditional treatments. As the field evolves, immunotherapy is expected to solidify its role as a key component of modern oncological treatment.