Kidney Cancer Awareness Month Spotlights Early Symptom Recognition, Current Challenges, and Key Treatment Advancements

Kidney Cancer Awareness Month |
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As Kidney Cancer Awareness Month, observed annually in March, came to a close, I. Alex Bowman, MD, underscored how educating both patients and providers about the early signs of kidney cancer; highlighting current treatment advancements; and encouraging greater support of ongoing research could facilitate more timely diagnosis and ultimately enhance outcomes for patients at all stages of this complex disease.

“In the future, the goal [of kidney cancer research] is going to be to figure out how we can expand that group of patients who could potentially be cured of this disease,” Bowman said in an interview with OncLive®. “We're incorporating and adding new immunotherapy agents and combinations to [current approaches] to try to improve those outcomes.”

In the interview, Bowman expanded on the significance of Kidney Cancer Awareness Month for recognizing symptoms and supporting families of those patients with a kidney cancer diagnosis; highlighted shifts in the kidney cancer treatment paradigm with the introduction of HIF-2α inhibitors and continued use of immunotherapy–based regimens; and noted the ongoing challenges in improving outcomes for patients with metastatic disease.

Bowman serves as the co-director of the Genitourinary Oncology Program at Banner MD Anderson Cancer Center and is an adjunct assistant professor at The University of Texas MD Anderson Cancer Center in Gilbert, Arizona.

OncLive: What is the importance of awareness initiatives like Kidney Cancer Awareness Day for improving disease detection, patient education, and access to treatment?

Bowman: Kidney Cancer Awareness Month is important for a variety of reasons. For the most part, we have screening for a lot of cancers; however, we don't have routine screening recommendations for kidney cancer, so we don't need to raise awareness for [that aspect of cancer care]. There are certain genetic syndromes where folks are at higher risk for kidney cancers, such as von Hippel-Lindau disease [VHL], tuberous sclerosis complex [TSC], and Birt-Hogg-Dubé syndrome [BHD]; those folks do need to have conversations with their provider about screening. However, in general, most folks with kidney cancer are diagnosed almost accidentally. They have imaging performed for some other reason, or they present with symptoms such as fatigue, flank pain, blood in the urine, etc. [Accordingly], part of the reason to raise awareness of kidney cancer is to raise awareness about those symptoms, which obviously can be seen in a lot of other conditions. It doesn't mean [a patient] has kidney cancer if they see a little bit of blood in their urine; however, we want to raise awareness [and encourage patients] to bring that to their provider’s attention.

It's also important to highlight the advances that are being made through research and bring that to the forefront. We [need] to encourage folks to continue to support research, which is the only way that we're going to continue to make advances in improving patient outcomes. Finally, raising awareness for kidney cancer is important to support the patients and their families who are going through this challenging diagnosis.

What are some of the key modifiable and non-modifiable risk factors for kidney cancer, and how can oncologists guide patients in risk-reduction strategies?

Several factors are associated with an increased risk of kidney cancer, some of which are modifiable, and some of which are not. It is not a disease like lung cancer, where there's a very clear, identifiable risk factor like smoking, although smoking does increase your risk of kidney cancer and is obviously unhealthy for a whole host of reasons. The main things that we look out for are uncontrolled hypertension and chronic kidney disease. Especially in the later stages, chronic kidney disease does raise your risk of kidney cancer. There are certain environmental exposures that, for the most part, folks fortunately aren't around all the time. [This includes] certain kinds of insecticides, industrial chemicals, and solvents, and things like that. There have been some data showing an increased risk of kidney cancer [with exposure to these environmental factors], but they are not something folks are going to run into in the course of their day-to-day life.

The challenge with kidney cancer is that there are honestly not a ton of modifiable risk factors other than focusing on health and exercise, [which] reduce the risk of cancer in general. The recommendation is [that patients and providers should be] on the lookout for symptoms. [Patients should not] ignore things if they pop up, and [they should] try to live a healthy lifestyle.

What emerging agents or advancements in kidney cancer do you think will have the biggest impact on the field going forward?

Our treatment of patients with kidney cancer has greatly evolved over the last 20 years. We started with TKIs, which are medicines that target blood vessel growth in kidney cancer. They changed the [treatment] landscape in the late 2000s and were the first [truly] effective agents in kidney cancer. Then we started getting immunotherapy agents approximately 10 years ago, and a lot of our research since then has been focusing on different ways to use these medications and combinations or sequences to try and improve outcomes.

There is a new class of medications that's been approved in certain circumstances for the last couple of years: HIF-2α inhibitors. One of these agents, [belzutifan (Welireg)], is FDA approved [in pretreated advanced RCC], but there are others currently being investigated. [The goal of current research in this space] is to figure out how we can combine that medication and potentially move it up earlier in the treatment line.

Other novel immunotherapy agents are being investigated, as well. For example, we're in the process of opening a clinical trial with a bispecific antibody, which is a more novel immunotherapy approach [for kidney cancer]. We're expecting the readouts on some of these clinical trials, particularly for the HIF-2α inhibitors, at some point [in 2025].

What challenges do patients with kidney cancer still face throughout their treatment journey, and how might these be addressed going forward?

The goal of kidney cancer management is obviously to cure patients. In cases where the cancer hasn't spread, we’re [potentially] able to do that. Where we're not able to [cure patients] nearly as often or reliably as we need to be is when the cancer has spread and metastasized. We do sometimes see responses to immunotherapy that are so good that patients with kidney cancer can be considered [cured]. However, optimistically, that's happening maybe 20% to 25% of the time, and it typically happens with a combination of immunotherapy agents.

We're working on improving survival, helping folks live longer, and helping them live with fewer symptoms when going through treatment. All of those are important goals. In the end, what really matters to the patient is whether we get rid of their disease. Eventually, [we hope that] these folks will be treated with the intent of getting rid of their disease in most cases.