Kidney cancer 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.

Tests in patients are called clinical trials. The 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.

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.

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.

There is a trial of sorafenib in people with von Hippell Lindau syndrome. Researchers want to find out whether sorafenib (Nexavar) can slow down the growth, or reduce the size, of kidney cysts or kidney cancer in people with von Hippell Lindau syndrome. Sorafenib is a type of biological therapy.

Cancer Research UK is also 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.

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.

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.

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.

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
• Growth factor blockers
• Blood vessel growth blockers
• MTOR blockers
• Vaccines

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. There is a trial looking at a new treatment called ABR-217620, to see if giving it with interferon helps to fight advanced kidney cancer. ABR-217620 is made up of 2 proteins. One of these 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. The trial has closed and we are waiting for the results.

There is another trial looking at a monoclonal antibody called cG250, to see if it helps to stop clear cell kidney cancer from coming back after surgery.

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 the side effects of drugs may be reduced by stopping and starting the treatment, without affecting how well the drug works. In this trial, researchers want to compare taking sunitinib continuously with having planned treatment breaks.

The PISCES trial is comparing sunitinib with a tyrosine kinase inhibitor called pazopanib (Votrient) as a first treatment for kidney cancer that has spread. 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. The PRINCIPAL study and the Pazo2 study are looking to see how well pazopanib works for advanced kidney cancer and how it affects quality of life.

One trial is looking at giving the TKI 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).

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.

One 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.

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. 

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 which 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 metastatic clear cell kidney cancer. You can find information about the bevacizumab and everolimus trial on our clinical trials database. 

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.

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

Vaccines are a type of immunotherapy. Cancer vaccines are designed to try to stimulate the body's own immune system to fight the kidney cancer. A trial is looking at a vaccine called IMA901 with sunitinib for advanced renal cell cancer. The people who have IMA901 will also have lower than usual doses of cyclophosphamide chemotherapy and GM-CSF. This is to help the IMA901 vaccine work better. The aim of the trial is to see if IMA901, cyclophosphamide and GM-CSF alongside sunitinib helps people with advanced kidney cancer more than sunitinib alone.

There is quite a bit of research going on into chemotherapy for kidney cancer, although it is not used as often as it is for some other cancers. This is because better treatment results have been gained with other types of treatment such as biological therapies. But new 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 – that is, in the bladder, kidney or 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.