Summary of Kidney Cancer Highlights from ASCO GU 2026

The American Society of Clinical Oncology Genitourinary Cancers (ASCO GU) Symposium was held from 26-28 February 2026, in San Francisco, California, USA. The presentations are available on the ASCO website. IKCC partner organisations attended the meeting to keep up to date with the care and treatment of kidney cancer patients. A brief ‘Take home messages’ section is followed by more in-depth review of selected abstracts.

Please note: The following summary was prepared for the benefit of patient advocates and patient organisations around the world who focus on kidney cancer. While this summary has been medically reviewed, the information contained herein is based upon public data shared at this meeting and is not intended to be exhaustive or act as medical advice. Patients should speak to their doctor about their own care and treatment.

 

Take home messages

Abstract 490 shared IKCC Global Patient Survey findings: Kidney cancer impacted emotions for most North Americans, yet few sought support or spoke with healthcare professionals—particularly in Canada and the USA. Importance: Improved communication and referrals to reliable support groups and counselling can address emotional needs more effectively.

Abstract LBA 418 showed the combination of pembrolizumab plus belzutifan after kidney cancer surgery helped more patients stay cancer-free compared to pembrolizumab alone, and it was safe. Importance: These findings suggest that this new combination could become standard treatment for people with clear cell RCC who are at high risk of their cancer coming back. Overall survival data is not yet mature.

Abstract 420 showed that patients receiving adjuvant durvalumab plus tremelimumab reported they felt worse at week 16 compared to patients on active monitoring, particularly in overall health, daily activities, tiredness, and sleep. Importance: Treatment decisions should consider the effect of treatment on overall health and quality of life alongside how well the treatment works.

Abstract 473 reported a study of adjuvant pembrolizumab in patients with non-clear cell RCC. The study showed that giving pembrolizumab after surgery did not have a clear benefit compared to just monitoring patients. Importance: A prospective, randomised cooperative group study is planned for patients with papillary RCC.

Abstract 537 reported that KIM-1 and ctDNA levels in the blood were strongly linked to patient outcomes after metastasis-directed treatment in patients with oligometastatic clear cell RCC. Importance: Combining these tests with clinical information with the K-COMPASS tool provides a useful way for doctors to make treatment decisions based on a patient’s risk.

In abstract 445, changes in blood IgG (an antibody) levels stand out as a particularly useful sign for predicting how patients with advanced clear cell RCC will respond to treatment with immunotherapy plus TKI combinations in the first line.

Abstract 457 shows that nivolumab is a helpful and safe second-or third-line treatment for kidney cancer that has spread. Importance: Checking the NER (neutrophil-to-eosinophil ratio) before starting nivolumab can give doctors useful information about how well a patient might do on treatment.

In abstract 493, casdatifan alone shows potential in advanced, heavily pretreated kidney cancer, linking a reduction in blood erythropoietin (a hormone that stimulates the bone marrow to create red blood cells) levels to positive outcomes. Side effects were tolerable, supporting larger studies.

In abstract 417, the combination of belzutifan and lenvatinib helped patients with advanced kidney cancer live longer without their cancer getting worse compared to cabozantinib. Importance: This is the first major study to show that a HIF-2α inhibitor (like belzutifan) combined with a TKI (like lenvatinib) can work better than a modern standard of treatment for advanced kidney cancer after immunotherapy.

Abstract 437 presented real life data showing that the risk of dying or the cancer getting worse was lower for advanced kidney cancer patients taking cabozantinib as a second-line treatment after ipilimumab plus nivolumab. Importance: This study suggests that cabozantinib is a good choice for patients whose kidney cancer has progressed after first-line treatment with ipilimumab plus nivolumab. Please note the results of the study in abstract 417 above.

In abstract 461, real world data from patients with metastatic papillary RCC who received cabozantinib plus nivolumab as initial therapy remained on treatment longer than those given cabozantinib alone, but overall survival was similar for both groups. Importance: These findings require further confirmation due to study limitations, including lack of randomisation and potential group differences.

Abstract 513 shows that giving cabozantinib and nivolumab before kidney surgery is safe and doable for newly diagnosed patients with high-risk advanced kidney cancer. Importance: The rate of complete response – where the cancer is gone – was 9% in this group of patients.

Abstract 429 shows that an AI tool can look at kidney scans and predict the most common type of kidney cancer more accurately than a manual reading of the scan based on the size of the tumour. Importance: This approach could provide doctors with helpful information before surgery, potentially reducing the need for biopsies in some patients and supporting better treatment decisions.

 

Summaries

IKCC Global Patient Survey

Abstract 490: Emotional concerns due to kidney cancer and differences in patient support across North America

Support services for kidney cancer patients are important. They can help patients feel better emotionally, improve their quality of life and lead to better health results. The IKCC and its partners run a survey every two years to find out what patients and carers experience when it comes to living with kidney cancer, getting diagnosed, and managing treatments. This helps them spot problems and differences between countries and come up with ideas to improve things. This abstract shares results from the 2025 survey about emotional wellbeing and support for patients in North America compared to the rest of the world.

The survey was created by a team of patient advocates, doctors and experts. The survey was for kidney cancer patients and their carers. It was translated into 16 languages and could be completed online or on paper.

2,677 people from 46 countries took part in the survey between 24 September and 15 November 2025 – 2,049 patients and 628 carers. This included 266 from Canada, 220 from the USA and 131 from Mexico.

In the past year, most people (85%) worldwide said kidney cancer or kidney growths affected their feelings at all stages of the disease. The most common feelings were anxiety about the illness (half of the people), fear that the cancer would come back (half of the people), sadness or depression (a third), fear of dying (a third), and trouble coping with daily life, work, or school (a quarter). Only around half of those surveyed spoke to a healthcare professional about these feelings and around 1-2 people in 10 found these talks were not helpful.

People from Mexico were more likely to discuss their emotions with a healthcare professional than those from Canada or the USA.

Around half of those surveyed joined a patient support group, online or in person, but this varied by country. About half found these groups helpful, and only 3 in 100 did not find them helpful. Websites run by patient organisations and online support groups were thought to be most useful, but again this differed depending on the country.

Many people said they wanted more counselling or psychological support, more face-to-face help, peer support and online support.

Most people in North America said kidney cancer affected their feelings, but many did not join a support group or talk to a healthcare professional about their worries, especially in Canada and the USA. There needs to be better communication between patients, carers and healthcare professionals to help with emotional challenges. Sending patients to trusted support groups, especially those offering in-person meetings and counselling, could help fill in gaps in emotional support.

 

Adjuvant treatment to stop recurrence of kidney cancer after surgery

Abstract LBA 418: Adjuvant pembrolizumab plus belzutifan for clear cell RCC: LITESPARK-022 study

Pembrolizumab (an immunotherapy infusion) is currently the standard adjuvant treatment given to patients with clear cell renal cell carcinoma (RCC) (the most common type of kidney cancer) who are at higher risk of their cancer coming back after their kidney tumour has been removed. Researchers want to find out if combining pembrolizumab with another medicine called belzutifan (a HIF-2α inhibitor tablet) could help more people. The LITESPARK-022 study compared pembrolizumab plus belzutifan with pembrolizumab plus a dummy tablet (a placebo) in patients with a high risk of their cancer returning after surgery.

The study included 1,841 patients whose kidney cancer had not spread but still had a high chance of it coming back after surgery. Patients were randomly allocated one of the two treatments for about a year.

After about two and a half years, patients who had received pembrolizumab plus belzutifan were less likely to see their cancer return compared to those on pembrolizumab plus placebo. At two years, about 8 in 10 of the patients in the pembrolizumab plus belzutifan group were cancer-free, compared to three quarters in the pembrolizumab (plus placebo) group. There was a 28% lower risk of the cancer returning or the patient dying with pembrolizumab plus belzutifan, compared to pembrolizumab alone. There are not enough data yet to say whether the combination helped people live longer overall.

Most patients finished treatment as planned. Serious side effects were reported by about half of the patients in the combination treatment group and about a third of those who got pembrolizumab (plus placebo). The most common side effects were anaemia (low red blood cells), raised liver enzyme levels (liver function problems), and low oxygen levels. Safety was similar between groups, with no unexpected problems.

The combination of pembrolizumab plus belzutifan after kidney cancer surgery helped more patients stay cancer-free compared to pembrolizumab alone, and it was safe. These findings suggest that this new combination could become standard treatment for people with clear cell RCC who are at high risk of their cancer coming back.

 

Abstract 420: Patient-reported outcomes for patients receiving adjuvant durvalumab and tremelimumab in the RAMPART study

The RAMPART study looked at two immunotherapies called durvalumab and tremelimumab for the treatment of patients with kidney cancer. Durvalumab was given on its own (monotherapy) or in combination with tremelimumab to patients with kidney cancer who had their cancer surgically removed (nephrectomy). This is called adjuvant therapy.

The main aim of this study was to find out how effective durvalumab, either alone or with tremelimumab, is at stopping kidney cancer from spreading and returning after surgery.

Early results showed that giving patients durvalumab and tremelimumab after their kidney cancer had been removed by surgery helped stop the cancer from coming back, especially for those who had the highest risk of their cancer returning. At ASCO GU 2026, patient-reported outcomes were presented for the group of patients treated with adjuvant durvalumab plus tremelimumab and compared to active monitoring.

Patients took part in an optional quality of life survey and filled out a questionnaire at the start and at least one more time during the study (at week 16 or month 15). The researchers measured several things, like overall health and quality of life, how well people could function, symptoms, and money worries at both week 16 and month 15.

254 patients completed the optional quality of life survey (150 in the active monitoring group and 104 in the durvalumab plus tremelimumab group).

At week 16, patients in the durvalumab plus tremelimumab group reported feeling worse than those in the active monitoring group in overall health and quality of life, how well they could do daily activities, tiredness and sleeping problems. These differences were big enough to matter for their health and wellbeing.

By month 15, the durvalumab plus tremelimumab group still had worse scores for pain and mental sharpness. Again, these differences were big enough to be important.

In summary, patients in the durvalumab plus tremelimumab group felt worse at week 16 than those in the active monitoring group, especially in overall health, daily activities, tiredness and sleep, and these differences were important. Things seemed to get better by month 15, but pain and mental sharpness were still worse for the patients in the durvalumab plus tremelimumab group. When choosing treatments, it is important to think about the effect of treatment on overall health and quality of life along with how well the treatment works.

 

Abstract 473: Adjuvant pembrolizumab for patients with non-clear cell RCC after nephrectomy

The immunotherapy, pembrolizumab, given after kidney surgery, helps some patients with clear cell RCC live longer without their cancer coming back. However, it is not clear if this benefit also applies to patients with less common types of kidney cancer, called non-clear cell RCC. To find out, researchers looked at the outcomes for non-clear cell RCC patients who had kidney surgery and then either received pembrolizumab or were just monitored.

The researchers looked at how long patients stayed cancer-free after surgery (disease-free survival, DFS) and how long they lived overall and compared the two groups (pembrolizumab and monitoring).

There were 90 patients in the study, 15 of which received pembrolizumab. The cancer came back in just under half of patients in both groups. There was no clear difference in how long patients stayed cancer-free or lived overall, whether they received pembrolizumab or not.

This study of patients with non-clear cell RCC who had their kidney removed showed that giving pembrolizumab after surgery did not show a clear benefit compared to just monitoring patients. A larger study is planned to see if more detailed analysis can reveal any advantages in certain patient groups.

 

Biomarkers for kidney cancer

A biomarker is a sign in your blood, urine, or body tissue that tells doctors something about your health or if you have a disease. In cancer, this could be a special protein found in your blood, a protein made by the cancer itself, or even a change in the genes inside the cancer cells. Biomarkers can do lots of things. They can help doctors find out if someone has cancer, work out how a person might respond to a treatment, and give clues about what might happen with the disease in the future.

Right now, doctors predict how things will go for people with kidney cancer by looking at the size and spread of the cancer (the stage), how much the cancer cells look like normal cells (the grade), the type of kidney cancer, and the person’s overall health. There aren’t any tests that can reliably show how well a person will respond to kidney cancer treatment or what the outcome will be, based just on a biomarker. Finding a good biomarker could help doctors choose the best treatment for each person and help them get the most benefit from their care.

Four interesting presentations at ASCO GU this year looked at biomarkers for kidney cancer: kidney injury molecule-1 (KIM-1), circulating tumour DNA, immunoglobulin G (IgG), neutrophil-to-eosinophil ratio (NER), and erythropoietin levels in the blood.

 

Abstract 537: Kidney injury molecule-1 (KIM-1) and circulating tumour DNA (ctDNA) as a predictive biomarker in advanced kidney cancer

This study looks at two promising tests to help predict outcomes in patients with advanced kidney cancer: one checks for a protein called kidney injury molecule-1 (KIM-1), and the other looks for bits of cancer DNA in the blood (circulating tumour DNA or ctDNA).

In a recent study, clear cell RCC patients with up to five metastatic tumours (oligometastatic disease) were given metastasis-directed treatment (such as surgery, thermal ablation, or stereotactic radiotherapy), but no anti-cancer medication. Blood samples were taken before they started treatment and again three months later to measure KIM-1 and ctDNA. To help predict how patients might do, researchers created a scoring system called K-COMPASS.

112 patients were tested in the study. Both KIM-1 and ctDNA levels in their blood were linked to how long patients went without needing further treatment, both at the start of the study and after three months. KIM-1 levels were also related to how long patients lived without their cancer getting worse (progression-free survival) and their overall survival, both at the beginning of the study and after three months.

The researchers also found that starting levels of KIM-1, ctDNA and other clinical information (such as past treatments, general health, number of metastases and time from diagnosis to spread) in the K-COMPASS tool were important for predicting outcomes. The K-COMPASS tool was shown to be quite accurate and is available online for doctors to use.

This is the first time KIM-1 has been studied in oligometastatic clear cell RCC, and the first time KIM-1 and ctDNA have been looked at together. Both tests were strongly linked to patient outcomes after metastasis-directed treatment. Combining these tests with clinical information with the K-COMPASS tool provides a useful way for doctors to make treatment decisions based on a patient’s risk. The researchers plan to test the tool further with other groups of patients.

 

Abstract 445: Blood IgG: A novel predictive biomarker for clear cell RCC patients receiving first-line immunotherapy combined with tyrosine kinase inhibitors (TKIs)

Combinations of immunotherapy and tyrosine kinase inhibitors (TKIs) as the first treatment helps people with metastatic clear cell RCC live longer. However, there is still a need for a simple test to predict how well patients will do on this treatment.

Researchers looked at the records of 121 patients with clear cell RCC who had received immunotherapy plus TKI as their first treatment. They wanted to find out if certain blood tests, such as the levels of immunoglobulin G (IgG) and the ratio of neutrophils to lymphocytes (two types of white blood cell), a prognostic score (the modified Glasgow prognostic score) and a risk score could help predict how well patients would do. They compared how long patients lived without their cancer getting worse (progression-free survival) and overall survival across different groups of patients.

At the start of the study, IgG blood levels were similar for all patients. After three months of treatment with an immunotherapy plus TKI combination, patients whose cancer improved had a big drop in IgG, those whose cancer remained stable had little change in IgG levels, and those whose cancer got worse had an increase in IgG. Higher IgG levels after three months were linked to a higher risk of the cancer coming back or dying. Other factors, like a high-risk score, high prognostic score, high neutrophil to lymphocyte ratio at the start of the study also pointed to worse outcomes.

When considering all factors together, changes in IgG levels and the prognostic score at the start were the strongest predictors of patient outcomes. At 16 months, changes in IgG levels were better at predicting whether the cancer would get worse than the other tests.

In summary, changes in blood IgG levels stand out as a particularly useful sign for predicting how patients with advanced clear cell RCC will respond to treatment with immunotherapy plus TKI combinations in the first line.

 

Abstract 457: Neutrophil to eosinophil ratio (NER) as a predictive biomarker in patients with metastatic kidney cancer treated with immunotherapy

Nivolumab is an immunotherapy that helps the body’s own immune system fight cancer. This study looked at how well nivolumab worked and how safe it was for patients. The researchers also looked at a blood test called the neutrophil to eosinophil ratio (NER) to see if it could help predict how patients would do.

A total of 149 kidney cancer patients were enrolled in the study. All patients had previously received anti-cancer medication; some had tried two different treatments before starting nivolumab.

The NER test looked at the levels of two types of white blood cells, neutrophils and eosinophils. Patients were split into two groups depending on whether their NER was high or low. The study measured how long patients lived without their cancer getting worse (progression-free survival) and how long they lived overall.

On average, patients lived nearly 10 months before their cancer got worse and just over two years overall. Nearly a third of patients had their tumours shrink. Serious side effects were reported by about 15% of patients, the most common being liver, joint and kidney problems. Patients who were more unwell when they started nivolumab, did not live as long.

Patients with high NER had shorter survival times than those with low NER. When looking at several factors together, the general health of the patient and the level of lactate dehydrogenase (a protein that is release when body tissues are damaged or diseased) in their blood were the most important predictors of how long they lived.

Overall, this study shows that nivolumab is a helpful and safe second- or third-line treatment for kidney cancer that has spread. Checking the NER before starting nivolumab can give doctors useful information about how well a patient might do on treatment.

 

Abstract 493: Effectiveness and biomarker analysis of casdatifan, a new HIF-2α inhibitor in clear cell RCC

Studies looking at the genes of people with kidney cancer have shown mutations in a gene called the von Hippel-Lindau (VHL) gene. This results in high levels of a protein called hypoxia-inducible factor, or HIF-2α in tumour cells. HIF-2α causes changes in the cancer cells resulting in the growth of the tumour. A new treatment, called a HIF-2α inhibitor, is a tablet that blocks the action of HIF-2α and tumour growth.

Researchers are testing casdatifan, a HIF-2α inhibitor, for advanced kidney cancer that hasn’t responded to other treatments. The study examined the effectiveness and safety of casdatifan in advanced kidney cancer patients, and its impact on erythropoietin levels in the blood. Erythropoietin is a hormone primarily produced by the kidneys that stimulates the bone marrow to create red blood cells, regulating oxygen delivery to tissues.

127 patients with high-risk clear cell RCC took varying doses of casdatifan. Researchers tracked safety, tumour response, progression-free survival, and changes in erythropoietin levels in the blood.

Most patients had intermediate or poor-risk kidney cancer, and all had received prior therapies and had stopped responding to treatment. Casdatifan shrank tumours in a third of cases, and progression-free survival was up to 12 months. Casdatifan reduced erythropoietin, which was maintained for a year. A larger erythropoietin drop aligned with better patient outcomes. Some patients needed dose reductions due to anaemia and low oxygen, but few stopped treatment.

Casdatifan alone shows potential in advanced, heavily pretreated kidney cancer, linking a reduction in blood erythropoietin levels to positive outcomes. Side effects were tolerable, supporting larger studies.

 

Second-line treatments for advanced/metastatic kidney cancer

Treatments for people with advanced/metastatic kidney cancer have changed over the past decade, resulting in big improvements in patient outcomes and survival. But sadly, for most people with metastatic disease, the cancer eventually starts growing again, even with treatment. That’s why researchers are still working hard to find new medicines or different combinations of treatments that can help people live longer with kidney cancer.

In many countries, doctors now usually give a combination of medicines as the first treatment for advanced or metastatic kidney cancer. These are medicines that block blood supply to the tumour (called TKIs) along with immunotherapy drugs that help the body’s own immune system fight the cancer. This combination works better than using just the TKI medicine alone: more patients respond to treatment, their cancer stays under control for longer, and they live for more months or even years. However, unfortunately for most patients, their cancer eventually gets worse on current treatments. It’s still not clear which treatment or combination works best after the cancer starts growing again.

 

Abstract 417: Belzutifan plus lenvatinib compared to cabozantinib as a second-line treatment for advanced kidney cancer after immunotherapy: LITESPARK-011 study

The LITESPARK-011 study is a large international trial looking at two different treatment options for patients with advanced kidney cancer that has progressed after immunotherapy: a combination of belzutifan (a HIF-2α inhibitor) plus lenvatinib (a TKI) compared to cabozantinib (a TKI). The study included patients whose cancer had already worsened after immunotherapy, whether they received it as their first, second or as an extra treatment after surgery (adjuvant treatment).

A total of 747 patients with advanced clear cell RCC were chosen at random to get either belzutifan plus lenvatinib or cabozantinib. Patients could join the study if their cancer got worse after immunotherapy, or within six months of finishing adjuvant immunotherapy after surgery. About half of the patients received belzutifan plus lenvatinib, and half received cabozantinib. Patients were followed for up to two and a half years.

Those who got belzutifan plus lenvatinib had their cancer controlled for longer before it grew again (an average of about 15 months), compared to those who had cabozantinib (an average of about 11 months). More tumours shrank with the combination treatment. Patients on belzutifan plus lenvatinib also saw their tumours respond for nearly twice as long as those on cabozantinib (23 months compared to 12 months). However, the overall length of life (overall survival) was not yet significantly different between the two treatment groups, and researchers will track this further.

Serious side effects happened in 8 out of 10 patients in both groups. A small number of patients died, with very few deaths directly linked to the treatment itself.

The combination of belzutifan and lenvatinib helped patients with advanced kidney cancer live longer without their cancer getting worse and helped shrink their tumours more often than cabozantinib. There was a 30% lower risk of the cancer getting worse with the combination compared to cabozantinib. While patients lived a bit longer overall with the combination, this difference was not large enough to be certain yet. The side effects were like what is already known about these medicines. This is the first major study to show that a HIF-2α inhibitor (like belzutifan) combined with a TKI (like lenvatinib) can work better than a modern standard of treatment for advanced kidney cancer after immunotherapy.

 

Abstract 437: Second-line treatment after ipilimumab and nivolumab in advanced kidney cancer: A real-world study

Ipilimumab plus nivolumab is commonly used together as a first-line treatment for intermediate- or poor-risk kidney cancer patients with advanced disease. But there is not much information about which treatment works best if the cancer gets worse after this first-line treatment. This study looked at how well patients did after receiving second-line treatment in real-life situations.

The researchers looked back at the records of 356 patients with advanced kidney cancer. All these patients’ cancer had eventually worsened after first-line treatment with ipilimumab plus nivolumab. The researchers wanted to see how well their second-line treatment worked and whether it was safe.

Cabozantinib was the most common second-line treatment given, and patients taking it lived longer and had longer periods without their cancer getting worse compared to other treatments. Other treatments included sunitinib, axitinib, pazopanib, lenvatinib plus everolimus, and tivozanib. With cabozantinib, patients lived for an average of 38 months and their cancer stayed under control for 15 months. With the other treatments, patients lived for an average of 16 months and their cancer stayed under control for 7 months. The risk of dying or the cancer getting worse was lower for patients taking cabozantinib.

This study suggests that cabozantinib is a good choice for patients whose advanced kidney cancer has progressed after first-line treatment with ipilimumab plus nivolumab. See also the results presented from the LITESPARK-011 study in abstract 417 above, which suggest a combination of belzutifan plus lenvatinib works better than cabozantinib after immunotherapy.

 

Abstract 442: Second-line treatment after cabozantinib plus nivolumab or lenvatinib plus pembrolizumab in advanced kidney cancer: A real-world study

Cabozantinib plus nivolumab and lenvatinib plus pembrolizumab are two treatment combinations that are very effective and have been approved for use as first-line treatment for patients with advanced kidney cancer in several countries. However, when the cancer stops responding to these medicines, doctors don’t know how well the next treatments work. In this study from America, researchers looked at patient records to see which medicines were given next and how well patients did after getting second-line treatment following cabozantinib plus nivolumab or lenvatinib plus pembrolizumab.

The study included 66 patients who received second-line treatment after cabozantinib plus nivolumab and 37 patients who received second-line treatment after lenvatinib plus pembrolizumab. Second-line treatments included a TKI, immunotherapy, a HIF-2α inhibitor, an immunotherapy combination or immunotherapy plus TKI combinations.

This study looks at which treatments patients received after their cancer progressed on cabozantinib plus nivolumab or lenvatinib plus pembrolizumab. The second-line treatments worked, but not as well as hoped. These finding show that we need better treatments for patients whose cancer has stopped responding to first-line medicines. The results will help doctors and researchers plan future studies and talk to patients about their options.

 

Treatments for non-clear cell RCC

Non-clear cell RCC is a rare group of cancers comprising over 20 types of kidney cancer. They account for about 20–25% of kidney cancer diagnoses. Patients with these cancers typically have shorter survival compared to those with clear cell RCC. Their rarity makes it difficult to conduct large treatment studies, so the best treatments are uncertain and improved options are needed.

At ASCO GU 2026, real-world experience with treatments for papillary RCC were presented, as well as the results from a trial looking at adjuvant pembrolizumab for non-clear cell RCC (see abstract 473 above).

 

Abstract 461: Real world comparison of first-line cabozantinib with cabozantinib plus nivolumab in patients with metastatic papillary RCC

Papillary RCC is the most common non-clear cell RCC. There are two main treatments used for metastatic papillary RCC: cabozantinib alone or cabozantinib plus nivolumab combination. Because there haven’t been any big studies directly comparing these treatments, both are considered standard treatment options, and further research is ongoing. In this study, researchers wanted to find out which treatment works best using real world patient data.

The researchers looked back at patient records from a large database in America (the Flatiron Health Research Database) to identify patients with metastatic papillary RCC who had received cabozantinib alone, or a combination of cabozantinib plus nivolumab as their first-line treatment. They looked at how long patients stayed on their first treatment before needing a new one and how long they lived overall.

Researchers identified 115 patients for the study, 65 were on cabozantinib and 50 were on the combination treatment. When the data was adjusted to make the two groups more similar, patients who had just cabozantinib needed to change treatment after an average of about 6 months, while those on the combination lasted about 16 months before changing treatment. The average survival was 20 months for cabozantinib alone and 26 months for the combination.

In summary, patients with metastatic papillary RCC who received a combination of cabozantinib plus nivolumab as their first treatment stayed on treatment longer than those on cabozantinib alone. However, there was no clear difference in how long patients lived overall between the two treatment groups. These results are a starting point and need to be confirmed in future studies, as the current research has limitations, such as no random assignment to treatments and possible differences between the groups.

 

Neoadjuvant treatment for kidney cancer

Abstract 513: Cabozantinib plus nivolumab before cytoreductive surgery for advanced kidney cancer: The Cyto-KIK study

The effectiveness of combinations of immunotherapy and VEGFR TKI targeted therapy is well established for advanced kidney cancer, but only 1 in 10 patients see their cancer disappear completely. Removing the kidney tumour (a procedure called cytoreductive nephrectomy) helps to reduce the amount of cancer in the body and might boost the immune system. The combination of cabozantinib plus nivolumab has been shown to be a good first-line treatment for advanced kidney cancer. This study looks at whether giving these medicines before removing the tumour (neoadjuvant treatment) might trigger a stronger immune response and improve the chances of the cancer going away.

There were 38 previously untreated patients with advanced kidney cancer in this phase II study. Patients were given cabozantinib and nivolumab before and after surgery. The main goal of the study was to see how many patients had a complete response to treatment, and their cancer disappeared. Patients were given 12 weeks of the combination treatment until 2 weeks before surgery and continued treatment after surgery until their cancer got worse.

Other aims of the study included checking how much the tumour shrank, how patients responded, how well the surgery went, and how long patients lived without their cancer worsening (progression-free survival).

Three-quarters of patients had moderate-risk cancer, the rest had high-risk cancer. All patients took at least one dose of study medication, but six patients didn’t have surgery. Of 35 patients, nearly a quarter had their tumours shrink, while the rest had stable disease. For the 32 patients who had surgery, half responded to treatment (for 3 patients, their cancer disappeared, and for 13 patients their cancer shrank). Six patients had at least 95% shrinkage of their cancer. On average, the tumour shrank by 19%. Five patients had nearly all cancer cells killed (more than 90% tumour cell death).

Everyone had mild or moderate side effects to treatment, and about 1 in 10 patients had severe side effects. There were no unexpected safety issues.

This study shows that giving cabozantinib and nivolumab before kidney surgery is safe and doable for patients with advanced kidney cancer. The rate of complete response – where the cancer is totally gone – was 9% in this group of patients with high-risk, newly diagnosed cancer.

 

The use of artificial intelligence (AI) in kidney cancer

Abstract 429: Predicting clear cell RCC from CT scans using artificial intelligence (AI)

Clear cell RCC is the most common type of kidney cancer found in adults. Usually, if someone has a localised kidney tumour, doctors treat it by removing part or all the kidney, or sometimes by monitoring small tumours closely. Before surgery, it is often hard to tell exactly what type of tumour it is, unless a sample is taken with a needle (biopsy). However, even biopsies aren’t always reliable because tumours can be quite mixed.

In this study, the researchers wanted to see if they could predict the type of tumour by looking at CT scans using artificial intelligence (AI).

The researchers looked back at the health records of patients who had surgery to remove their kidney tumours and had CT scans taken before their operation. They used a special AI computer programme (called ResNet-50) to see if it could tell the difference between clear cell RCC and other types, just by looking at the scans. They compared the accuracy of the AI by reading the scans manually and making a diagnosis based on tumour size.

AI was tested on 1,642 patients from the same hospital. For all these patients, AI could correctly tell if the tumour was clear cell RCC much better than looking at the size of the tumour manually. There were 822 patients with tumours between 3 and 7 cm. For this group, AI was even better. When the researchers tested the AI on patients from outside their hospital, it was still better than a manual read of the scan based on size alone in the 3-7 cm group.

In summary, this research shows that an AI tool can look at kidney scans and predict the most common type of kidney cancer more accurately than a manual reading of the scan based on the size of the tumour. This approach could provide doctors with helpful information before surgery, potentially reducing the need for biopsies in some patients and supporting better treatment decisions.

 

Acknowledgements:

Editor: Professor Eric A. Singer (USA)

Medical Reviewers: Professor Stênio de Cássio Zequi (BR)

Professor Axel Bex (NL/UK)

Medical Writer: Dr Sharon Deveson Kell (UK)