A kidney cancer diagnosis brings a whole array of emotional turmoil and uncertainty about tomorrow to anyone’s life. Adding to them are fear and challenging treatment decisions, making the recovery path seem like a faraway dream. For decades, treatment followed a predictable path: surgery where possible, and limited options once the disease advanced. But, over the last 10 years, that picture has changed as immunotherapy emerged as a glimmer of hope to many stage 4 kidney cancer patients in India.
Surgery Remains the First Line of Defence
In most early stage kidney cancers, surgery (total or partial nephrectomy) remains the first line of treatment. Depending on tumour size and location, this may be a partial nephrectomy, removing only the affected portion of the kidney, or a total nephrectomy, removing the kidney entirely. However, in cases where the cancer has spread to other organs or has a risk of recurrence, surgery alone is not enough. Targeted therapies with oral tyrosine kinase inhibitors became the standard of care in stage IV kidney cancer. Further research in this space continued as response rates in stage 4 disease remained limited.
Immunotherapy Emerged as A Turning Point
{{/usCountry}}Immunotherapy Emerged as A Turning Point
{{/usCountry}}Immunotherapy introduced a whole new strategy in cancer care. Receiving the U.S. Food and Drug Administration (FDA) approval in 2015, Nivolumab (Opdivo) became the first immune checkpoint inhibitor approved to treat stage 4 advanced kidney cancer. This new therapy is considered a more natural form of care as it unlocks the body's own immune response, allowing T cells to identify and destroy cancer cells. It also has fewer side effects than chemotherapy and offers better outcomes and a better quality of life. Today, immunotherapy is being used across almost all cancer types, and in earlier stages also. The practice of its use has also shifted considerably, with immunotherapy increasingly used as a first-line or adjuvant treatment rather than a last resort.
Mahesh is a living example on how immunotherapy can work in advanced stage kidney cancer and give sustained response. He had progressive stage IV kidney cancer in 2016, with no standard therapy available. His deterioration led to ICU admission with a very poor prognosis. Treatment with immunotherapy was the latest advance that year, and this was discussed as a possible new treatment option. He received treatment with Nivolumab, and showed a dramatic complete response, which has now sustained for the last 10 years, even after stopping treatment in 1 year! His story gives us hope that immunotherapy can work in advanced disease, a situation where not much was possible a decade back!
Combination Approaches: No Single Solution
Immunotherapy does not work uniformly across patients, and this variability has pushed cancer care toward trying combination strategies. These include pairing 2 immunotherapy agents, combining immunotherapy with chemotherapy, and integrating it with targeted therapies such as oral tyrosine kinase inhibitors or antibody-drug conjugates. Together, these approaches reflect a broader move toward more personalized, precision-based cancer care, one still very much in progress.
This article is written by Dr. Amit Rauthan, HOD & Consultant - Medical Oncology, Immunotherapy and Precision Medicine, Manipal Hospital, Old Airport Road, Bengaluru.
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