DR. SANJAY GOGOI,CHAIRMAN, UROLOGY ,MEDANTA – THE MEDICITY
The kidneys are vital organs responsible for filtering toxins from the blood, removing waste through urine, and maintaining the body’s fluid and electrolyte balance. However, kidney cancers account for about 2% of all cancer cases in India, according to the Indian Council of Medical Research, placing them among the top ten most common cancers in the country.
For many years, treatment options for advanced kidney cancer—also known as metastatic renal cell carcinoma (RCC)—were limited, offering only modest improvements in survival. Historically, the five-year survival rate hovered around 15%. But over the past decade, there has seen a remarkable transformation: the arrival of targeted therapies and immunotherapy has significantly improved patient outcomes, with survival rates rising with targeted therapies and immunotherapy.
Targeted Therapies: Starving the Tumour
Targeted therapies are designed to strike directly at cancer cells while sparing healthy tissue. In RCC, many of these treatments focus on blocking angiogenesis—the process by which tumours create new blood vessels to sustain their growth. By cutting off this supply of oxygen and nutrients, angiogenesis inhibitors slow down tumour progression.
Commonly used drugs such as sunitinib, pazopanib, cabozantinib, and axitinib have become standard first-line treatments for advanced RCC, offering significant gains in both progression-free and overall survival compared to traditional chemotherapy.
Immunotherapy: Mobilizing the Immune System
Immunotherapy takes a different approach, empowering the body’s own immune system to fight cancer. One of the most effective methods in RCC involves checkpoint inhibitors — which block proteins such as PD-1 and CTLA-4 that normally prevent immune cells from attacking cancerous cells. By releasing these brakes, checkpoint inhibitors enable immune cells to recognize and destroy tumours.
Medications such as nivolumab, pembrolizumab, and ipilimumab have delivered impressive results in clinical trials, extending survival and, in some cases, achieving long-term remissions where the cancer disappears entirely.
Combination Therapies: The Best of Both Worlds
An exciting development is the use of combination therapies, where immunotherapy is paired with targeted drugs. Clinical studies show that combining a checkpoint inhibitor with an angiogenesis inhibitor can yield better outcomes than either treatment alone. As a result, such combinations are becoming an increasingly common choice for advanced RCC.
Looking Ahead
The landscape of kidney cancer treatment continues to evolve. Researchers are developing more selective targeted drugs, advancing new immunotherapy techniques, and studying biomarkers to identify which patients will benefit most from specific treatments. These innovations point toward a future of more personalized, effective therapies—offering hope and improved survival for patients facing this challenging disease.
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