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Kidney cancer research

All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know that they are safe.

First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to test are they tested in people, in clinical trials. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

There is research into

 

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Why we need research

All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that

  • We can be sure they work
  • We can be sure they work better than the treatments that are available at the moment
  • They are known to be safe

First of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS. Cancer Research UK supports a lot of UK laboratory research into cancer.

Tests in patients are called clinical trials. Cancer Research UK supports many UK and international clinical trials.

Our trials and research section has information about what trials are including information about the 4 phases of clinical trials. If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials recruiting in the UK. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. On the database you can also find out about trials that are closed and about trial results.

All the new approaches covered here are the subject of ongoing research. Until studies are completed and new treatments are found to work better than existing treatments, they cannot be used as standard therapy for cancer of the kidney.

 

Research into kidney cancer cells and markers

Researchers are always trying to find out more about what causes certain types of cancer. There is a large study in Scotland collecting blood and tissue samples from people with kidney cancer and other types of cancer. Researchers will study these samples, along with information about how well people respond to treatment, to find out what they can tell us about the causes of kidney cancer.

There is another study looking for substances (biomarkers) that could help tell doctors how kidney cancer is developing or how well a treatment is working. Doctors are taking blood and urine samples from people with kidney cancer and from healthy volunteers. They want to see if there are differences between the samples that may lead to a test that could help with the treatment of kidney cancer in the future.

 

Genetics and kidney cancer research

Quite a lot of work has been done on genes that might increase kidney cancer risk. Researchers are looking into ways to try to predict who carries genes that increase kidney cancer risk. If they can do this, doctors could screen those people and treat them early if kidney cancer did develop.

Cancer Research UK scientists are looking at the von Hippell Lindau gene (vHL) to try to find out more about the process that leads to kidney cancer developing. Particular faults in the gene lead to very specific things happening in kidney cells. The scientists are looking for these gene faults and finding out what they do. We hope that this work will lead to new treatments that block kidney cancer growth. 

Recent research found that that mutations in a gene called PBRM1 are present in up to a quarter of patients with renal cell carcinomas, the type that accounts for 90% of kidney cancers. This finding might help researchers to develop tests and treatment in the future.

Cancer Research UK is supporting a trial looking into the genetic causes of kidney cancer. This trial is looking at people who may have an inherited genetic fault or a medical condition that increases their risk of getting kidney cancer.

The GPKC study is looking at the genetics of a type of kidney cancer called papillary renal cell cancer. The researchers are looking at blood and tumour samples from people who have been diagnosed with this type of cancer.

 

Research into surgery for kidney cancer

Surgeons and researchers continue to try to improve the results of cancer surgery and improve quality of life after surgery. Research is looking at combining surgery with newer drug treatments. 

The CARMENA trial is looking at whether surgery helps people who are having the biological therapy sunitinib (Sutent) for clear cell kidney cancer that has spread to other parts of the body. Treatment for advanced kidney cancer has improved during the last few years with the development of new biological therapy drugs such as sunitinib. 

If the cancer has spread outside your kidney, having an operation to remove your kidney (a nephrectomy) will not cure the disease. A nephrectomy is a big operation to have. In the past, having surgery to remove the kidney helped some people to live longer. But with the new types of biological therapy now available, doctors don’t know if people still benefit from having this type of surgery. This trial aims to find out if having surgery to remove the kidney as well as sunitinib is better at treating clear cell renal cancer than sunitinib on its own.

The SURTIME trial is looking at the best time to have surgery for clear cell kidney cancer that has spread. The doctors want to find out if it is better to have your kidney removed before taking sunitinib or after you have taken it for a while.

 

Heat treatment

This is commonly known as microwave thermotherapy. Clinical trials have been done using this new treatment for a number of different types of cancer, including kidney cancer. It involves heating the kidney using microwave energy to kill off the cancer. This is very experimental and we need results from more trials before this would be considered standard treatment for any type of cancer.

 

High intensity ultrasound treatment

HIFU stands for high intensity focused ultrasound. This means that strong beams of sounds are directed precisely at the cancer and are capable of killing cancer cells. Doctors think this may be an alternative to surgery for some people. Trials have looked at HIFU for kidney cancer that can't be removed by an operation and they have also looked at HIFU before surgery. We need more research into HIFU before we know whether it is a helpful treatment for kidney cancer.

 

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) is an experimental treatment which uses a light activated drug. We don't know yet how much it helps people with kidney cancer. There is a study looking at treating small kidney tumours with PDT. The treatment is called vascular targeted photodynamic therapy (VTP). It uses a light activated drug called WST 11, which you have through a drip into the vein. 

To have the treatment, the doctor puts laser fibres into the tumour to activate the drug. This damages the blood vessels that feed the tumour and can shrink the tumour. If research shows that it helps, future patients may be able to have PDT for small tumours instead of surgery.

 

Biological therapy

Biological therapy is treatment that can control the growth of cancer cells by changing or blocking chemical pathways in the cells. We have detailed information about biological therapy. And there is information about using biological therapies for kidney cancer in this section. 

You can find out more about biological therapy trials for kidney cancer on our clinical trials database. Go to the advanced search and choose 'kidney cancer' from the dropdown menu of cancer types and 'biological therapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.

The types of biological therapies currently being researched for kidney cancer include

Monoclonal antibodies

Some biological therapies are monoclonal antibodies that target particular proteins on the surface of the cancer cells. In recent years, cancer researchers have developed a number of biological treatments that are being tested in different types of cancer. 

A trial looked at a new treatment called naptumomab estafenatox to see if giving it with interferon could help to fight advanced kidney cancer. Naptumomab estafenatox is also called ABR-217620 and is made up of 2 proteins. One protein recognises the cancer cells, and the other stimulates the body's immune system to attack them. People in the trial had either interferon with ABR-217620, or just interferon. Overall, the combined treatment did not help people to live longer than interferon alone. But in some people with particular types of tumour it did help them to live longer. So researchers want to carry out more studies to see if naptumomab could help patients with particular types of kidney cancer.

The CA209025 trial is comparing a new monoclonal antibody called nivolumab with everolimus for renal cell cancer that has spread. The researchers want to see if nivolumab works better than everolimus for advanced kidney cancer in people who have already had another type of biological therapy that blocks blood vessel growth to cancer cells (anti angiogenic drugs).

Growth factor blockers

Many of the new biological therapy drugs are growth factor blockers. They are designed to stop cancer cells growing. Some of these drugs are known as tyrosine kinase blockers (inhibitors) or TKIs for short. Tyrosine kinases are chemical messengers (an enzyme) that play a part in the growth of cancer cells. 

The SUCCINCT trial is looking at combining the TKI drug sunitinib (Sutent) with GC chemotherapy for transitional cell cancer of the lining of the bladder, the pelvis of the kidney, or the tube that links the two (the ureter). The trial is for people whose cancer is locally advanced or has spread to another part of their body. It aims to find out whether adding Sutent to GC chemotherapy works better than GC chemotherapy alone and to find out which side effects it causes.

The STAR trial is comparing 2 ways of taking sunitinib for advanced kidney cancer. We know from research that for some cancers stopping and starting the treatment can reduce the side effects without affecting how well the drug works. In this trial, researchers want to compare taking sunitinib continuously with having planned treatment breaks.

The PISCES study compared sunitinib with a tyrosine kinase inhibitor called pazopanib (Votrient) as a first treatment for kidney cancer that had spread (advanced kidney cancer). The researchers wanted to see if one drug caused fewer side effects than the other. They did this by asking people about the side effects and if they would prefer taking one drug rather than the other (a patient preference study). The researchers found most people preferred taking pazopanib to sunitinib. The main reason for this was a better quality of life and feeling less tired with pazopanib.

The PRINCIPAL study and the Pazo2 study are trying to find out more about how well pazopanib works for advanced kidney cancer and how it affects people's quality of life.

The PANTHER trial is looking at pazopanib before surgery for kidney cancer that has spread to another part of the body. The researchers want to find out if there is a benefit to starting pazopanib before surgery and whether it causes any problems if you have pazopanib before surgery. Another trial is looking at pazopanib after surgery for kidney cancer. The researchers want to find out if giving pazopanib after surgery stops kidney cancer from coming back or delays its return and helps people stay free of cancer for longer.

One trial is looking at giving the drug sorafenib (Nexavar) to people whose kidney cancer has not spread anywhere else, and has been removed surgically. The researchers want to find out if it stops or slows down the cancer coming back, and how long it should be taken for. There is also a trial to see if sorafenib will shrink, or slow down the growth of, kidney cysts or kidney cancer in people with the genetic condition known as von Hippel Lindau syndrome

There is also a trial comparing a new drug (TKI258) with sorafenib in people who have clear cell kidney cancer that has come back after treatment (recurred). Another study is looking at TKI258 to treat transitional cell kidney cancer that has spread into the surrounding tissue (is locally advanced), or to another part of the body. The aims of this study are to find out if TKI258 can help people with advanced transitional cell cancer and what side effects it may cause.

The A-Predict trial is looking at the TKI axitinib for renal cell cancer that has spread. The researchers aim to find out if axitinib helps treat people with advanced kidney cancer who have not had surgery and to learn more about the side effects.

Blood vessel growth blockers

Other types of biological therapies have been researched for kidney cancer. These include drugs such as thalidomide that reduce the blood supply to tumours to stop them growing. Doctors call these types of drugs anti angiogenic treatments.

The COSAK trial is a phase 2 trial looking at 2 new anti angiogenic drugs. The trial is testing cediranib (also known as AZD2171) and saracatanib (also known as AZD0530) for people with clear cell kidney cancer that has spread to other parts of the body. The trial aims to find out if a combination of cediranib and saracatanib works better than cediranib on its own for clear cell kidney cancer that has spread. It also wants to learn more about the side effects of these 2 drugs.

Another trial is looking at a new biological therapy called E7080. This drug works by blocking the growth of new blood vessels to the cancer. The trial is comparing E7080 and everolimus to find out which is the best to treat advanced kidney cancer.

Tasquinimod also works by blocking the growth of new blood vessels to the cancer and by helping the body's immune system. A trial is looking at tasquinimod for advanced cancer of the liver, ovary, kidney or stomach. This trial has now closed and we are waiting for the results.

The EuroTARGET study is looking at blood and tissue samples and treatment outcome to see if these will one day help doctors predict how people with kidney cancer will respond to anti angiogenic drugs. The researchers are looking for differences in people's DNA that may predict ho well treatments may work. They look at how each person responds to treatment, and see if there are any links between this and what they find in the samples. And they also look for proteins and other substances in the cancer that may give information about how sensitive the cancer is to the drug. 

MTOR blockers

MTOR blockers (inhibitors) stop a particular protein called mTOR from working properly. mTOR controls other proteins that trigger cancer cells to grow. 

One study is looking at the mTOR blocker everolimus for advanced kidney cancer that has spread to another part of the body. Everolimus has the brand name Afinitor. Doctors sometimes use everolimus for advanced kidney cancer that has come back either during or after treatment. The researchers think that using everolimus before surgery may help people with advanced kidney cancer. The ASPEN trial is comparing everolimus with sunitinib for renal cell kidney cancer that has spread. 

The ROVER trial is comparing everolimus with a new type of mTOR blocker called GDC-0980 for advanced kidney cancer. This new drug also blocks other proteins that can trigger cancer cells to grow, such as PI3K.

Another trial is comparing a combination of bevacizumab (Avastin) and everolimus with a combination of bevacizumab and interferon. The trial aims to see which of these 2 drug combinations is best for people with clear cell kidney cancer that has spread. You can find information about the bevacizumab and everolimus trial on our clinical trials database.

The ZEBRA trial is comparing everolimus with a new cancer growth blocker called AZD2014. This new drug blocks more cancer cell signals than everolimus, and so researchers think it may work better for advanced kidney cancer. This trial has now closed and we are waiting for the results.

A trial called RAPTOR is looking at everolimus for kidney cancer that has spread to other parts of the body. This trial is for people who have a particular type of renal cell cancer called papillary renal cell cancer. The aim of this trial is to find out if everolimus can help people with advanced papillary kidney cancer. There is another trial comparing everolimus and sunitinib for the most common type of kidney cancer (renal cell cancer) that has spread to other parts of the body.

Another type of mTOR blocker is called temsirolimus. The ToTem trial is looking at temsirolimus with the chemotherapy drugs cisplatin and gemcitabine to treat transitional cell cancer of the centre of the kidney (renal pelvis), bladder, ureters or urethra. The trial is for people whose cancer has spread into surrounding tissue (locally advanced) or to another part of the body. The researchers want to find out if this combination of treatment works in treating advanced transitional cell cancer, what the side effects are, and the best dose to give.

Some renal cell cancers have large amounts of the growth factor receptors called EGFR and HER2. If the receptors are blocked, this can stop the cells from growing and dividing. A TKI drug called lapatinib (Tyverb) targets the receptors and has been tested in trials for advanced renal cell cancer. This research is still ongoing.

Vaccines

Cancer vaccines are designed to try to stimulate the body's own immune system to fight cancer. The immune system naturally attacks foreign cells that are invading the body, such as bacteria and viruses. Because cancer develops originally from normal body cells, cancer cells are harder for the immune system to spot. So one problem with kidney cancer and other types of cancers is that the patient’s own immune system does not think that the cancer is foreign and does not try to get rid of it.

Vaccines stimulate the immune system to recognise and destroy cancer cells. It is early days in kidney cancer vaccine research and this type of treatment is still highly experimental.

A UK trial of 64 people reported in May 2011. It found that people with advanced renal cell kidney cancer whose immune system responded to a vaccine called IMA901 lived longer than would normally be expected. This is encouraging and the researchers recommended that further research should be carried out. You can read about the results of the IMA901 vaccine trial on our clinical trials database.

There is now a phase 3 trial looking at a vaccine called IMA901 with the drug sunitinib and the growth factor GM-CSF, with or without the chemotherapy drug cyclophosphamide. The trial is also for people with advanced kidney cancer. The researchers want to find out more about how well the IMA901 vaccine works, whether giving cyclophosphamide helps IMA901 to work better, and if IMA901 can help people to live longer.

 

Chemotherapy research for kidney cancer

There is quite a bit of research going on into chemotherapy for kidney cancer. Chemotherapy does not work very well for the most common type of kidney cancer (renal cell cancer). But  better treatment results have been gained by combining chemotherapy with other types of treatment such as biological therapies. But new chemotherapy drugs are being developed all the time. And there are always clinical trials looking into these.

Different types of kidney cancer respond to different treatments. Chemotherapy is used more often for transitional cell cancer (TCC) than it is for renal cell cancer. Transitional cell cancer is a type of cancer that can develop anywhere in the urinary system – including the bladder, kidney or the tubes connecting them (the ureters). 

The ODMIT C trial looked at giving mitomycin C straight into the bladder after surgery for transitional cell kidney cancer. The aim of this treatment is to try to stop the cancer coming back in the bladder after the affected kidney has been removed. The research team found that giving mitomycin C into the bladder helped to stop the cancer coming back for some patients. It didn't cause any serious side effects. The research team advised that doctors should consider giving mitomycin C to all patients who have surgery for TCC of the kidney.

The GO-80 study is looking at combining gemcitabine with oxaliplatin, instead of cisplatin for transitional cell cancer that has spread. Oxaliplatin is similar to cisplatin but is less likely to damage the kidneys. So doctors hope that it will work as well at controlling the cancer but may cause fewer side effects.

Other drugs that have been tested in transitional cell cancer include docetaxel (Taxotere), cisplatin and tretinoin.

In renal cell cancer, trials are looking into combining chemotherapy and biological therapies. To find these and other kidney cancer trials, go to our clinical trials database. Select 'kidney' from the dropdown menu.

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Updated: 16 January 2014