Emerging Treatments and Future Directions in Metastatic Kidney Cancer

There is a series of emerging therapies and treatment approaches across various stages of development that are drumming up significant interest in the metastatic renal cell carcinoma space, according to an expert.

Dr. Sumanta (Monty) Kumar Pal, co-director of the Kidney Cancer Program at City of Hope in Duarte, California, recently spoke at CURE®’s Educated Patient® Kidney Cancer Summit and highlighted some of the more exciting developments that are on the horizon for the treatment of the most common type of kidney cancer.

“Some of these are agents that you've heard a lot about in forums or discussion groups, others I think are emerging and I think are probably at a phase where it's too early to discuss data, but at least we can discuss the novelty of these approaches,” Pal said during the presentation.

Microbiome-based therapies

One area that Pal said he was significantly interested in is the future role of microbiome-based therapy.

To provide insight into this development, Pal referenced a different presentation from the Summit where a colleague discussed frontline treatments and highlighted the role of biomarkers.

“One biomarker that we don't often think of is stool specimens,” he said. “You can certainly profile blood, you can profile tumor tissues, but you can also profile stool, and you can tease out what bacteria are within that stool nowadays.”

In fact, he cited data published in the journal Science that demonstrated that bacteria in the stool of people with lung and kidney cancer predicted if their disease would respond to therapy or not.

Pal — who was a co-chair of the Summit — also discussed research that his colleagues at City of Hope conducted using an over-the-counter product commonly used in Japan to treat gastrointestinal conditions.

The study assessed the efficacy of CBM-588, a live bacterial product, in combination with Opdivo (nivolumab) and Yervoy (ipilimumab) compared to Opdivo plys Yervoy given without CBM-588.

He explained that even though the study only included 30 patients, the data showed delays in cancer growth and an early signal for improved survival in those who received CBM-588.

“This is a very small study, but encouraging and (I hope) that we'll see more about the microbiome in years to come,” he said.

Interluekin-2

Another emerging therapy garnering interest in the space revolves around an agent that was once used to treat kidney cancer.

“High-dose interleukin-2 … cured (a) small proportion of patients with advanced kidney cancer,” he said. “But it was a small subset of a subset of patients that we were able to use this treatment, and it really hasn't sort of panned out as a widespread agent in clinical practice.”

That is until recently. Pal noted that researchers have made chemical modifications to bempegaldesleukin that may allow it to be delivered to patients in a safer fashion. He presented on data that showed a “nice, meaningful reduction” in tumor burden in patients who received the drug.

CAR-T cell therapies

Pal concluded the presentation focusing on the intrigue surrounding CAR-T cell-based therapies.

“This is a cool way of targeting cancer in the sense that you're actually engineering T cells to go after a specific and unique target,” he said.

Pal explained that the current strategy for using CAR T cells is targeting the CD70 tumor markers since it is “pretty pervasively expressed across kidney cancer cells.”

Although it’s still too early to share any data, he said, it is still something to consider, and he encouraged patients to do their research on what studies might be available.

“We’re really seeing CAR T therapies pan out in blood-based disorders such as myeloma (and) lymphoma; those are settings where I think that CAR T-based therapies are really inducing a transformative change.”

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