Until recently, radiation therapy has played a very limited role in the treatment of kidney tumors. But, as Kidney Cancer Awareness Month winds down, I want to share with you a promising discovery and new clinical research study that may introduce a new role for radiation in fighting this disease.
The research involves an area of cancer medicine known as immunotherapy. At its very basic level, immunotherapy entails changing the body’s own immune system so that it is capable of recognizing and attacking cancer cells, or basically boosting it into action. Our research has found that radiation could play a role in this process.
Radiation therapy previously was of little help in the treatment of kidney cancer partly because we had no way of pinpointing high enough doses of radiation to the tumor, while avoiding damage to healthy, surrounding tissue. But this has changed with the introduction of stereotactic body radiation therapy (SBRT), which allows us to precisely focus high doses of radiation right where we want it—at the tumor.
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With the advent of this new technology, and knowing from other cancers that radiation changes the immune makeup, or immune profile, of cancer cells, we began studying how radiation affected kidney cancer cells in particular. Again, previously there was little need for this knowledge since we had no way of delivering the radiation to the tumor in the first place.
What we found is that the immune profile of the kidney cancer cells did in fact change when it was radiated. It changed so much that the immune system was able to recognize the cancerous cells and the body’s T lymphocytes, or a type of white blood cell that help fight infection and sometimes cancer, were more capable of killing the cancer cells than if they were not radiated.
We will be opening a phase I clinical trial in the upcoming weeks to study this new approach in patients with metastatic disease, or cancer that has spread beyond the kidneys. The patients will first undergo radiation therapy to the tumor and then, four weeks later, surgical resection of the tumor. Throughout this time we will monitor the immune system and its ability to fight back against the cancer. We will also be able to determine whether the radiation allows us to spare more of the healthy kidney tissue than would have been possible without the radiation. This is known as a partial nephrectomy, or when only the kidney tumor is removed, leaving the healthy portion of the kidney intact. At Roswell Park, more than 90% of kidney surgeries are done as partial nephrectomies, which comes with certain advantages. Data has shown that patients undergoing partial nephrectomy have a longer survival than patients undergoing a radical nephrectomy (removal of the entire kidney) for the same tumor.
Kidney Cancer Vaccine Study
In addition to this study, we plan to open a clinical research study later this summer for patients that have localized kidney tumors. In this study, patients will also first receive a dose of radiation. The radiation will be followed by the administration of a vaccine, which is currently in the very early stages of development across the country, and then surgery to remove the tumor.
It is our hope that this study will lead us down the road to avoiding surgery altogether in the future and instead treating cancers of the kidney solely with immunotherapy by using other treatments, such as radiation, to change the profile of the cancer—shocking them into submission, so to speak.