Advanced kidney cancers are difficult to treat. Two clinical trials, presented at the European Congress of Oncology, bring promising results for better patient care.
- A little over 11,000 new cases of kidney cancer occur each year in France
- When this cancer is diagnosed early, the prognosis is good: 80% of patients are alive after 5 years
- More advanced cancers are more difficult to treat and resistance to treatment can occur
- Nivolumab and cabozantinib demonstrate better efficacy than current standard treatment
Nivolumab and cabozantinib: two complex names that could represent a big step forward in the treatment of patients with advanced kidney cancer. These molecules, evaluated in two independent clinical trials, had the honor of opening the European Cancer Congress (ECC), which takes place from September 26 to 29 in Vienna (Austria). The results, published simultaneously this Saturday in the New England Journal of Medicine, demonstrate for the two molecules a better efficiency than the current standard treatment.
A third of late diagnoses
Kidney cancer is little known to the general public, yet it affects nearly 340,000 people worldwide each year, including more than 11,000 in France. Detected early, it heals rather well: survival at 5 years reaches 80%. Unfortunately, in a third of cases, the diagnosis is made at an advanced stage, when metastases are already present. In this case, treatment failures are numerous, seriously threatening the survival of the patients.
It was precisely in patients who had failed treatment that nivolumab and cabozantinib were tested, in the trial Checkmate 025 for the first and the METEOR test for the second. Each protocol aimed to compare the effectiveness of these two molecules and that of the standard treatment, everolimus.
Anti-PD1 antibodies
After very remarkable results at the ASCO congress, in the treatment of lung cancer and melanoma, nivolumab once again created the event. The results presented by Padmanee Sharma, director of the immunotherapy platform at the MD Anderson Cancer Center (United States), indicate a significant improvement in the overall survival rate, 25 months against 19 with everolimus.
This efficiency has also led the investigators to stop the clinical trial sooner than expected, in order to suggest patients receiving standard treatment to switch to nivolumab.
This anti PD1 antibody has the advantage of causing fewer side effects than the conventional treatment. In addition, 25% of patients responded to immunotherapy, a response rate that may appear low, but only 5% responded to everolimus. Finally, the side effects reported by patients are less frequent with nivolumab.
Padmanee Sharma pointed out that anti-PD1 do not act on the tumor but directly allow the immune system to better fight cancer cells. “The survival benefits are currently seen with a 14-month follow-up, but we will continue to follow these patients, and we hope that there will be much longer-term effects,” commented the scientist. Previous work carried out in other types of cancer had indeed shown lasting effects of the treatment, even after stopping it.
Encouraging phase II
The METEOR trial is a little less advanced, and all the data have not yet been collected. Professor Toni Choueiri, associate professor at Harvard Medical School, therefore presented only a first series of results, however very promising. Patients’ “progression-free survival” is improved with cabozantinib compared to standard therapy. “The final evaluation of overall survival can only be done with a longer patient follow-up,” said Toni Choueiri. But overall, these results should give new hope to patients diagnosed with advanced kidney cancer, cabozantinib could become a new treatment option. ”
Price in the crosshairs
Padmanee Sharma and Toni Choueiri welcomed the progress made by their respective laboratories in the fight against so-called “clear cell” renal carcinoma, Professor Choueiri not hesitating to speak of “a real day of celebration for the patients”. Professor Martine Piccart, Belgian oncologist of international renown who chaired the presentation of these results to the press, after having welcomed the major progress made by this work, did not hesitate to bring to the table the subject that annoys: that of price.
“Immunotherapies cost about $ 10,000 per month. Today we are facing treatment costs that had never been seen before. The latest European data (also presented this Saturday at the ECC – Editor’s note) show significant differences in patient care between European countries. Some will not be able to afford these treatments, and perhaps even within countries, inequalities will develop, some patients will be able to access these therapies, others not ”.
A pessimistic observation, shared by many oncologists. At the last congress of the American Association of Clinical Oncology, several had addressed the subject during plenary presentations. Leonard Saltz, head of the gastrointestinal oncology department at the Memorial Sloan Kettering Cancer Center (New York), had made a calculation: the price per gram of ipilimumab (another immunotherapy molecule) is today ” 4000 times that of gold ”. Edifying!
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