Daniel George, MD: One of the most important and, I think, exciting areas of kidney cancer has been in the development of some new therapies to treat patients with newly diagnosed stage 4 recurrent or metastatic kidney cancer. These are the patients who may have undergone a kidney resection, and now the cancer has come back. It may have come back right away, or it may have been months or even a few years, but the cancer has come back. And most of the time, it comes back in another site—maybe it’s the bone or the lungs or the lymph nodes or the liver.
Wherever it is, that’s disease that we want to treat. We know that’s a marker for the cancer getting into the bloodstream and spreading to other parts of the body. It’s not always simply those spots but disease elsewhere. So, we’re going to use therapies that go everywhere. Historically, we’ve had pill therapy that targets the blood supply to the tumor. It’s worked in the majority of patients to slow the cancer. But inevitably, the vast majority of those patients progress.
We’ve looked at how patients progress. In just the last few months, we’ve now seen data suggesting that there are newer drugs that target additional pathways and control the cancer for longer periods of time—particularly, the most aggressive tumors. That’s what I’m most excited about. If we can tackle the most aggressive forms of kidney cancer, we’re going to be doing even better against the less aggressive forms. Those are always the hardest tumors to treat—the ones that are growing faster, causing symptoms, or spreading to more sites.
Those are the signs that will tell us that they’re aggressive, and we’ll use pill therapies, such as this new pill therapy called cabozantinib, which has shown greater activity and longer duration of control of cancer in this population. Additionally, there have been some data now (although it’s not FDA approved yet) that suggests that there are some immunotherapies that may work, as well, in the high-risk aggressive cancers—cancers that are more likely to kill the patient sooner because of the pace of the disease. They’re targeting the immune system. They use intravenous therapies to stimulate the immune system, to fight the cancer. They have not necessarily worked in everybody, but they have worked dramatically in a subset of patients. That’s always tremendously helpful for patients, because everybody wants to see a dramatic response. We don’t always get that.
But now, if we’ve got several different shots on goal, if you will—several different opportunities to get that exceptional response. That gives people hope, not just with the first treatment but also the second or the third, as well. I’ve seen that. I’ve seen patients who’ve progressed through 1 or 2 lines of therapy, who then get a dramatic response to something during their third time through.
That’s not always the case with cancers, but kidney cancer seems to be a cancer where, if we keep plugging away at it, every once in a while, we’ll get another breakthrough. Right now, in this last year or so, we’ve had a couple of breakthroughs. I don’t think we’re done. I think we’re going to see more. So, the longer that this generation of patients can live, the more they’ll benefit from these therapies.