This year’s European Society for Medical Oncology (ESMO) Congress was held from 17-21 October 2025, in Berlin, Germany. The presentations are available to read on the ESMO website. Some affiliates of the International Kidney Cancer Coalition (IKCC) went to the meeting to keep up to date with the care and treatment of patients with kidney cancer. In this report, 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

In abstract 2631P, the IKCC global patient survey revealed significant regional differences in patients’ involvement in treatment decisions. While most follow their treatment plans, outcomes may improve with better information and participation. Around 1 in 5 clinical trial participants were dissatisfied. The mental health impacts from kidney cancer are rarely discussed with doctors. Experiences differ widely across countries, highlighting a need for enhanced collaboration between patient groups and healthcare professionals.

Abstract 2592MO reported that combining fruquintinib and sintilimab was more effective and generally safe compared to axitinib or everolimus for patients with previously treated advanced kidney cancer. This combination will be submitted for a New Drug Application in China.

In abstract LBA96, a triple combination of pembrolizumab, lenvatinib, and belzutifan showed early promise and are now being assessed in a phase 3 trial. Side effects were consistent with known profiles of the individual drugs. Result of the ongoing phase 3 trial are awaited.

Abstract LBA93 presented early results from the RAMPART study. Giving people durvalumab and tremelimumab after their kidney cancer has been removed by surgery helped stop the cancer from coming back, especially for those who had the highest chance of their cancer returning.

In abstract LBA95 giving patients immunotherapy for six weeks before surgery helped shrink the tumours in some people with intermediate to high-risk clear cell kidney cancer. Most patients (95%) had stable disease. More research is needed to see if this treatment helps people live longer and to find out which patients are most likely to benefit from it.

Abstract 2635P showed that for people with metastatic kidney cancer who are doing well on immunotherapy it is likely safe to stop treatment after about two years instead of continuing for longer. This can help reduce side effects and the burden of treatment, without making a big difference in how long people live or how well the cancer is controlled.

Abstract LBA94 showed that for people with advanced clear cell kidney cancer whose disease got worse after previous immunotherapy, lenvatinib plus everolimus was better than cabozantinib at keeping the cancer under control. Yet no overall survival benefit was observed.

Abstracts 2595MO and 2600MO presented SUNNIFORECAST study results for a rare form of kidney cancer called chromophobe kidney cancer. The combination of ipilimumab and nivolumab improved survival in patients with chromophobe kidney cancer and worked better overall for those with high CPS markers. Immunotherapy may benefit people with rare kidney cancers, and PD-L1 testing could guide treatment choices. Further studies are required to confirm these outcomes.

Abstract 2605MO reported results from the CALYPSO study, which showed adding savolitinib to durvalumab did not seem to help most people with kidney cancer, except possibly for a small group with a specific gene change (MET). Combining durvalumab and tremelimumab led to higher response rates. Other measures, like how long people lived, were also not clearly better with the combinations compared to durvalumab alone.

Abstract 2591O found that testing tumour RNA helps doctors select effective treatments. Patients with kidney tumours that develop many blood vessels responded better to nivolumab and cabozantinib when chosen using these tests than with previous methods.

Abstract 2594MO presented biomarker findings from the COSMIC-313 study. Higher baseline KIM-1 levels were linked to poorer outcomes. Patients treated with nivolumab plus ipilimumab who showed a decrease in KIM-1 within four weeks had better results, unlike those on triple therapy. These findings indicate that monitoring KIM-1 may help predict prognosis and early drops in KIM-1 could signal effective immunotherapy in advanced kidney cancer.

In abstract 2613MO levels of CD8+ T cells which have a specific pattern of proteins (they have PD-1 but not TIM-3 or LAG-3) were measured in the tumour and could help predict which patients might benefit most from nivolumab plus ipilimumab for advanced kidney cancer. Researchers are also looking at whether combining this information with another biomarker called PD-L1 could make predictions even more accurate.

 

Summaries

Global kidney cancer patient survey

Kidney cancer rates are rising, increasing pressure on patients, families, and healthcare systems. Since 2018, the IKCC and its network have tracked global trends in diagnosis, management, and patient burden through a biennial global patient survey. The survey identifies patient experiences, unmet needs, and differences by country to inform recommendations for the diagnosis, management, care and treatment of kidney cancer patients globally. Some key findings from the survey were presented in a poster at ESMO 2025.

Abstract 2631P – Unmet needs in kidney cancer: The IKCC global patient survey 2024

 The survey was created for kidney cancer patients and caregivers by a steering committee from the IKCC network, in collaboration with kidney cancer patient advocates, medical experts, and the Picker Institute. It was tested to make sure it was reasonable through interviews with patients and caregivers. It was translated into 16 languages.

Between September and November 2024, a total of 2,677 individuals took part (2,049 patients and 628 carers) from 46 countries. Of these, half were male, 8 in 10 were aged 46–80 years, and two thirds had clear cell kidney cancer. One in 5 patients were stage 4 at diagnosis, with half of the patients being diagnosed within the last four years.

Key findings:

  • Just over half of people who answered the survey (55%) said they were involved in making decisions about their treatment as much as they wanted, but this differed from country to country.
  • Most patients (79%) taking targeted medicines continued with their treatment as planned. The main reasons people stopped or reduced their medication were side effects, feeling unwell, problems with daily life, or running out of tablets. The survey suggests that people are more likely to stick to their treatment if they are more involved in decisions and have good information about their health.
  • The vast majority (85%) said kidney cancer had affected their emotions, but only a third of those who felt anxious about their illness talked to their doctor or nurse about it.
  • Nearly two out of three people (62%) said they were never asked to join a clinical trial, but of those who were invited, two out of three (63%) took part. Of those who joined a clinical trial, most (77%) were happy with their experience.

The IKCC global patient survey is the only worldwide survey for people affected by kidney cancer, and 2024 saw the highest number of participants ever. The survey found that there are still big differences in how much patients feel included in making decisions about their treatment, depending on their country. Most patients stick to their treatment plans, but results could be better if patients had more information and were more involved in decision-making. About one in five people who took part in clinical trials were not happy with their experience. Many people said their mental health was affected by kidney cancer, but these feelings were rarely talked about with their doctors. Experiences vary a lot from country to country, showing there is more to learn and more ways for patient groups and healthcare professionals to work together.

 

Promising new treatments for advanced/metastatic kidney cancer

Abstract 2592MO – Fruquintinib plus sintilimab as second-line therapy for patients with advanced/metastatic kidney cancer

Fruquintinib is an oral anti-cancer medication (a VEGFR tyrosine kinase inhibitor, TKI) that works by blocking proteins that help tumours grow blood vessels, which cuts off the tumour’s supply of nutrients and oxygen. Sintilimab is a type of cancer immunotherapy that works by helping to restore the immune system’s ability to attack cancer cells.

This study, called FRUSICA-2, looked at how well a combination of fruquintinib and sintilimab worked compared to two other commonly used medicines in the second-line, axitinib and everolimus, for people whose kidney cancer had spread or could not be removed by surgery. These patients had already tried one type of targeted cancer medicine before joining the study.

In the study, 234 people were split into two groups: one group got the combination treatment, and the other group got either axitinib or everolimus. After following them for about 16 and a half months, it was found that people taking fruquintinib plus sintilimab had much longer periods where their cancer did not get worse (about 22 months) compared to those taking axitinib or everolimus (about 7 months). More than half of the people (about 61%) who took the combination saw their tumours shrink, compared to only about a quarter (24%) in the other group. The benefits were seen no matter how advanced the cancer was at the start.

The side effects were similar in both groups. The number of people who had to stop treatment because of side effects, or who died because of treatment, was similar in both groups.

In summary, the combination of fruquintinib and sintilimab worked better at controlling the cancer and was generally safe, offering people with advanced kidney cancer a more effective treatment option after their first medicine stopped working. The combination of fruquintinib plus sintilimab is being submitted for a New Drug Application in China.

 

Abstract LBA96 – First-line pembrolizumab combinations for advanced kidney cancer

KEYMAKER-U03 sub study 03A is part of a larger research study that is testing experimental treatments for advanced kidney cancer. The goal of sub study 03A is to evaluate the safety and efficacy of experimental combinations of medicines as a first treatment for patients with advanced clear cell kidney cancer. This sub study has two phases: a safety phase and an efficacy phase to see how well the treatments worked. The safety phase will be used to demonstrate a tolerable safety profile for the combination of investigational agents.

At the ESMO 2025 conference, researchers shared results from sub study 03A, the first part of the KEYMAKER-U03 study. In total, 393 patients took part in the study, with 353 of them being included in the main phase that tested how well the treatments worked. The patients were followed up for between 16 and 39 months, depending on which treatment group they were in.

The results showed how often serious side effects happened with each treatment combination. For example, with the quavonlimab, pembrolizumab plus lenvatinib triple combination, about three quarters of patients had serious side effects. The favezelimab, pembrolizumab plus lenvatinib triple combination had more side effects, and nearly 9 in 10 patients reported a serious side effect. In the other three treatment groups (pembrolizumab, belzutifan plus lenvatinib, vibostolimab, pembrolizumab plus belzutifan and the reference group; pembrolizumab plus lenvatinib) about 7 in 10 patients reported serious side effects.

These findings help doctors and patients understand the risks and benefits of new treatment options for advanced kidney cancer, showing both how well the medicines work and how likely they are to cause serious side effects.

The combination of pembrolizumab, lenvatinib, and belzutifan showed early signs that it might work well and is now being tested further in a larger phase 3 study. The side effects seen with each combination were what doctors expected based on what is known about the individual medicines.

 

Abstract LBA93 – Adjuvant therapy with durvalumab or durvalumab combined with tremelimumab for resected kidney cancer

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 have had their cancer surgically removed (nephrectomy). This is called adjuvant therapy.

The main aim of this study is to find out how effective durvalumab monotherapy and durvalumab plus tremelimumab are as adjuvant treatments for patients with kidney cancer at stopping the cancer from spreading and returning after surgery.

Patients at intermediate to high risk of their cancer returning after their nephrectomy were included in the trial to see if durvalumab monotherapy or durvalumab plus tremelimumab are effective at stopping the cancer from spreading and coming back. The effectiveness of these adjuvant treatments is compared with standard of care at the time, which was active monitoring.

The first results from the RAMPART study were presented at ESMO 2025.

Researchers enrolled 790 patients in the study and most had clear cell kidney cancer. The study found that people who got both durvalumab and tremelimumab had better results than those who were just closely watched without extra treatment. After two years, more than 8 in 10 people who got the drugs had not seen their cancer come back, compared to just over three quarters in the active monitoring group. This difference shows that the combination treatment may be more effective at keeping the cancer from returning.

Among patients who were considered higher risk, the benefit was even greater: 8 in 10 of those treated with both drugs were cancer-free at two years, compared to two thirds in the active monitoring group. There was no unexpected safety concern found with the combination treatment. The results comparing durvalumab to the active monitoring group will be available in the next year.

Giving people the medicines durvalumab and tremelimumab after their kidney cancer has been removed by surgery helped stop the cancer from coming back, especially for those who had the highest risk of their cancer returning.

 

Neoadjuvant treatment for kidney cancer

Abstract LBA95: Neoadjuvant immunotherapy in locally advanced clear cell kidney cancer at risk for recurrence or spread

The effectiveness of combinations of immunotherapy and VEGFR TKI targeted therapy is well established for advanced kidney cancer. This prompts further investigation into the potential effectiveness of these combinations of anti-cancer medications before surgery (neoadjuvant treatment). This phase 2 study aimed to look at the effectiveness of different combinations of neoadjuvant immunotherapy in patients with a clear cell kidney cancer tumour that is of intermediate to high-risk and can be removed with surgery.

In this trial patients were treated with either 2 cycles of nivolumab, 2 cycles of ipilimumab plus nivolumab or 2 cycles of relatlimab plus nivolumab for 6 weeks before surgery.

The results from this early analysis were shared at ESMO 2025. 42 patients were included in the main analysis (14 patients in each treatment group). Nearly all the tumours were advanced (stage T3 or higher) and about a quarter of patients had cancer in their lymph nodes. Tumour samples were collected pre- and post-treatment for most patients.

In this early look at the results, there were no significant differences between the treatments groups with respect to pathologic response to treatments (a pathological response is a measure of how well a cancer tumour responds to treatment, determined by a pathologist examining tissue samples under a microscope). Five of the 42 patients had a pathologic response to treatment, of which the nivolumab plus relatlimab and the nivolumab plus ipilimumab combinations each had 2 of 14 patients respond. Most patients (95%) had stable disease. This met the criteria to continue with the next stage of the study.

There were a small number of surgical complications in the combination treatment groups (ipilimumab plus nivolumab or relatlimab plus nivolumab, 7 and 14% respectively). With ipilimumab plus nivolumab, 4 in 10 patients experienced serious side effects. In the other two treatment groups, less than 15% of patients reported serious side effects.

More research is needed to see if this treatment helps people live longer and to find out which patients are most likely to benefit from it.

 

Does duration of immunotherapy treatment have an impact on patient benefit?

Abstract 2635P – How long should treatment last for metastatic kidney cancer patients responding to immunotherapy?

 This poster presentation looks at the big question: If people with advanced kidney cancer are doing well on immunotherapy, do they need to keep taking the medicine for more than two years, or is it OK to stop? Researchers studied patients who had been on these medicines for at least 21 months and were still responding well, without serious side effects. They compared people who kept taking the treatment beyond two years to those who stopped after that time. The goal was to find out if continuing treatment helps people even more, or if stopping is just as safe and effective.

A total of 95 patients took part in this study, and most had already had surgery to remove a kidney. Most people had kidney cancer that was considered intermediate risk, and almost all had the clear cell type, with about a third showing more aggressive (sarcomatoid) features. Just over half of the patients had their cancer come back after the first treatment.

A little over half of the patients were treated with a combination of two immunotherapy drugs (ipilimumab and nivolumab), while the rest had nivolumab. The results showed that nearly 6 in 10 patients saw their tumours shrink (partial response), and 4 in 10 had no signs of cancer left (complete response). On average, tumours shrank by 82%.

The study looked at how long people lived and how long the cancer stayed under control. After five years, more than 8 in 10 (84%) of those who kept taking immunotherapy were still alive, compared to two thirds of those who stopped after about two years. However, the difference in cancer-specific survival was very small, and the time the cancer stayed controlled (called progression-free survival) was also similar between the groups. Stopping immunotherapy early (after about two years) only made a small difference in outcomes—about 6%—meaning you would need to keep treating 17 people for one person to see a real benefit from continuing.

For those who chose to stop, the average time on treatment was about 29 months, with most stopping between two and three years. Stopping treatment early reduced the amount of medicine and possible side effects a lot, without making a difference in how well people did in the long run.

In summary, for people with advanced kidney cancer who are doing well on immunotherapy, it’s likely safe to stop treatment after about two years instead of continuing for longer. This can help reduce side effects and the burden of treatment, without making a big difference in how long people live or how well the cancer is controlled.

 

Promising second or third line treatment for advanced or metastatic clear cell kidney cancer

Treatments for people whose kidney cancer has spread or is advanced have improved a lot in the last ten years, which means patients are living longer and doing better. But sadly, for most people, 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 VEGFR TKIs) along with immunotherapy drugs that help the body’s own immune system fight the cancer. This combination works better than using just the VEGFR 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, it’s still not clear which treatment or combination works best after the cancer starts growing again.

Abstract LBA94 – Lenvatinib plus everolimus compared to cabozantinib in patients with metastatic kidney cancer that has failed immunotherapy

This phase II study is looking at two different treatment options for people with kidney cancer that has spread to other parts of the body and has got worse after previous immunotherapy treatment. The first option is a combination of two medicines, lenvatinib and everolimus. The second is a single medicine called cabozantinib. All three medicines work by blocking certain signals or enzymes that help cancer cells grow. The goal is to see which treatment does a better job at stopping the cancer from getting worse.

86 people were treated in this study: 40 got lenvatinib plus everolimus, and 46 got cabozantinib. The study followed people for an average of 20 months (just over a year and a half). During this time, 60 people saw their cancer start to grow again.

People treated with lenvatinib plus everolimus went about 16 months on average before their cancer started getting worse. For those treated with cabozantinib, it was about 10 months. This means the combination of lenvatinib plus everolimus helped keep the cancer under control for longer. The chance of shrinking the tumour was also higher with lenvatinib plus everolimus (about half of the patients responded), compared to cabozantinib (about 4 in 10 patients responded). Information about how long people lived overall is not yet complete.

In summary, for people with advanced clear cell kidney cancer whose disease worsened after immunotherapy, the combination of lenvatinib and everolimus helped keep the cancer under control longer than cabozantinib. This is the first study to directly compare these two newer treatments, so it helps guide what to try next. There’s no clear survival benefit yet.

 

Promising treatment for non-clear cell kidney cancer

Non-clear cell kidney cancers are a rare group that includes more than 20 different types of kidney cancer. They make up about 20–25% of all people diagnosed with kidney cancer. People with these types of kidney cancer usually do not live as long as those with the more common type, called clear cell kidney cancer. Because non-clear cell kidney cancers are so rare, it is hard for researchers to find enough patients to take part in big studies that compare treatments. As a result, doctors are not sure which treatment works best, and there is a real need for better options.

At ESMO 2025, the results from the patients with a rare type of kidney cancer called chromophobe kidney cancer from the European study called SUNNIFORECAST were presented, as well as updated results from the trial overall.

Abstracts 2595MO and 2600MO – Ipilimumab plus nivolumab compared to standard of care for non-clear cell kidney cancer

In the phase 2 SUNNIFORECAST study, 309 people with rare types of kidney cancer were split into two groups. One group was given a treatment combining two immunotherapy medicines called ipilimumab and nivolumab, while the other group received the usual treatments doctors use for this kind of cancer (mostly medicines called VEGFR TKIs, which block signals that help cancer grow). Some patients had these medicines together with immunotherapy or other treatments or did not get any treatment.

Most of the patients (about 6 out of 10) had a type of kidney cancer called papillary kidney cancer and nearly 2 out of 10 had chromophobe kidney cancer (59 patients). People with chromophobe kidney cancer are the second largest group of non-clear cell kidney cancers after papillary.

  • At the 12-month mark, nearly 9 out of 10 people who received the combination of ipilimumab and nivolumab were still alive, compared to about 3 out of 4 people who got the usual treatments.
  • On average, people with chromophobe kidney cancer who had the ipilimumab plus nivolumab treatment lived longer overall, and about a quarter of them saw their tumours shrink, compared to only 1 in 10 people on the standard treatments.
  • However, the length of time before the cancer started growing again (known as progression-free survival) was about the same for both groups.
  • The study also found that chromophobe patients whose tumours had higher levels of a marker called CPS (which can help predict how well someone might respond to immunotherapy) did much better on the immunotherapy treatment. On the other hand, chromophobe kidney cancer patients with a low CPS level did better with the usual treatments.

The results of this study show that people with a rare type of kidney cancer called chromophobe kidney cancer lived longer when treated with the combination of ipilimumab and nivolumab, compared to those who had other treatments. The study also found that this combination worked better overall for people with non-clear cell kidney cancer, especially for those whose tumours had higher levels of a marker called CPS (Combined Positive Score).

These findings suggest that using immunotherapy might help people with these rare types of kidney cancer, and that testing for the PD-L1 marker (which is measured with the CPS test) could help doctors decide which treatment might work best. However, more research and clinical trials are needed to confirm these results.

One of the main criticisms of this study is that some people in the standard treatment group received older medicines, and there are now newer treatments that combine immunotherapy and targeted drugs. These newer options might work just as well or even better than ipilimumab and nivolumab. Because these types of kidney cancer are so rare, international studies with more patients are important to get clearer answers. Still, this is the first study to compare an immunotherapy combination directly with the usual treatments in non-clear cell kidney cancer patients.

 

Potential biomarkers for kidney cancer

A biomarker is something that can be measured in your blood, urine or body tissue to show if your body is healthy or if you have a certain disease. For cancer, a biomarker might be a protein found in your blood, a protein made by the cancer itself, or a change in your genes. Biomarkers can be very useful; they can help doctors diagnose cancer, predict how well a treatment might work, and give clues about how the illness might progress in the future.

Currently, doctors decide how well someone with kidney cancer might do by looking at things like how advanced the cancer is, how abnormal the cells look under a microscope, the specific type of kidney cancer, and the person’s general health. But there aren’t yet any reliable markers that can tell us how each person might respond to treatments or what their outcome will be. Finding good biomarkers could allow doctors to tailor treatments to each patient, giving them the best chance of success and improving their outcomes.

This year at ESMO 2025, there were some exciting talks about biomarkers for kidney cancer. Many of the major studies look for biomarkers that could predict how well people with advanced kidney cancer would respond to treatment.

Abstract 2605MO – Efficacy data and biomarker analysis from the CALYPSO study

The CALYPSO study tested three medicines — durvalumab, tremelimumab, and savolitinib — in people with advanced kidney cancer who had already tried other treatments. The goal was to see which worked best and whether certain gene changes in the tumour made a difference.

The best results were seen with durvalumab plus tremelimumab, helping about 3 in 10 people. Those who responded stayed well for around a year and a half. Adding savolitinib didn’t help most patients, except possibly a small group with a specific MET gene change.

Overall, no treatment clearly helped people live longer, but the study gives clues about which combinations and which patients might benefit most in the future.

 

Abstract 2591O – Results from the OPTIC RCC study of a novel RNAseq-based biomarker

The OPTIC RCC study is testing a new way to choose treatment for advanced kidney cancer. Researchers used special RNA tests to see how each tumour behaves, either ‘angiogenic’ (grows many blood vessels) or ‘inflamed’.

People with angiogenic tumours received nivolumab plus cabozantinib. Among 21 patients with follow-up scans, every tumour got smaller or stayed stable, and none grew during treatment. About two thirds had a clear response, lasting around 10 months so far.

Some patients had serious side effects, including blood clots. Using RNA tests to guide treatment helped many respond better than usual, but this approach is still experimental and not yet part of routine care.

 

Abstract 2594MO – Link between blood kidney injury molecule-1 (KIM- 1) levels and clinical outcomes in advanced kidney cancer

The COSMIC-313 study looked at whether a blood marker called KIM-1 could help predict how people with advanced kidney cancer respond to treatment. High KIM-1 levels are linked to worse outcomes, while low levels may mean better response to treatment.

In this study, patients received either two immunotherapy drugs (nivolumab and ipilimumab) or a triple combination adding cabozantinib. People with higher KIM-1 levels at the start tended to live for a shorter time.

For patients on nivolumab plus ipilimumab, an early drop in KIM-1 was a good sign, their cancer stayed under control longer. This pattern wasn’t seen with the triple combination. Measuring KIM-1 in the blood could one day help doctors predict who will benefit most, but it’s not yet used in routine care.

 

Abstract 2613MO – Identifying biomarkers of response to first-line nivolumab plus ipilimumab therapy in patients with metastatic clear cell kidney cancer

Nivolumab plus ipilimumab is a first treatment option for advanced kidney cancer, but it doesn’t work for everyone. Researchers are studying biomarkers to see who benefits most.

In this study, scientists looked at immune cells called CD8+ T cells in tumour samples from patients in the COSMIC-313 trial. People with more of a specific type of these cells (with PD-1 proteins but not TIM-3 or LAG-3) before treatment were more likely to see their tumours shrink and their cancer stay under control longer.

This suggests that checking for these CD8+ T cells could help doctors predict who will respond best to nivolumab plus ipilimumab. Researchers are also exploring whether combining this with another marker, PD-L1, can improve accuracy.

 

Acknowledgements:

Editor: Professor Yüksel Ürün (TR)
Medical Reviewers: Professor Stênio de Cássio Zequi (BR) and Professor Axel Bex (NL/UK)
Medical Writer: Dr Sharon Deveson Kell (UK)