Sandy Liu, MD, reviews the current challenges and recent advances in the treatment of renal cell carcinoma, or kidney cancer, as well as what she looks most forward to in the coming years.
PUBLISHED June 18, 2018
Sandy Liu, MD: Right now, it’s an exciting time for kidney cancer, but there is still a lot of work to be done. The greatest unmet need is that we are helping patients, but we’re just helping a subset of patients. There is still a great majority of patients who do not respond to the therapies or who progress pretty rapidly. For example, immunotherapy is wonderful. It’s shown to have a great response and great survival benefit, but just a small majority of patients respond, about 20%. We need to make sure the other 80% are taken care of. Patients who respond to oral targeted agents respond for just a brief amount of time, and they move on to the next therapy. We need to make sure that we’re helping more patients, that we’re able to potentially cure some of the patients with immunotherapy. But we hope to cure more patients with immunotherapy in the future.
What’s exciting now is that we have a lot of clinical trials that combine immunotherapy and targeted agents, as well as other novel agents for kidney cancer. Maybe a cure is on the horizon for these patients, as well as for patients who have stage 3 disease, where we want to prevent the cancer from recurring. That’s another area that we’re trying to work on. We do have a drug approved for these patients, but it is highly toxic and most patients prefer not to take it, so it is a discussion we have with them.
Right now, there are a lot of clinical trials that are ongoing for these unmet needs with a lot of exciting combinations—immunotherapy plus targeted agents, and a lot of novel agents that have been combined with immunotherapy—so we can better capture appropriate patients and help more patients, not just a subset of patients. We’re finding more molecular targets to approach. When I see a patient, I do genetic sequencing, and sometimes we pick up mutations that we’re able to target. Finding better targeted therapies for patients, or combination therapies, can all help meet these unmet needs for patients.
The one that we have is the targeted immunotherapy combination with an oral targeted agent that has shown to be very effective. In the coming years, probably in the next year or so, the data from the combination of an oral agent plus immunotherapy will read out, and it might be the next new standard of care to treat kidney cancer: using combined agents instead of single agents, either targeted or immunotherapy. That is coming out very soon on the horizon.
For me, it’s very gratifying now in 2018 to treat kidney cancer, because the field has moved very rapidly dramatically. If I were (treating) kidney cancer 20 years ago, there would not be many options I could give to patients. But today, there are so many options that are available. Patients are doing well. They’re living longer, and with the advent of newer targeted agents, combined agents and immunotherapy, it’s really gratifying for me to treat kidney cancer patients, because they are living longer than the projected survival that’s set out for kidney cancer. I’m very excited to treat these patients, because we have a lot of options.