Advanced Treatment For Metastatic Renal Cell Carcinoma

India is experiencing a concerning rise in kidney cancer cases, with an estimated 16,861 new cases diagnosed each year.

Alarmingly, nearly one-third of these patients are diagnosed with advanced-stage disease, leading to higher mortality rates compared to more developed countries. Metastatic Renal Cell Carcinoma (mRCC), characterised by the spread of tumours beyond the kidneys, poses a particularly aggressive threat.

However, advancements in treatment options provide a ray of hope for individuals grappling with this challenging condition.

Treatment Landscape

The mainstay of treatment for mRCC in India has been systemic therapy, with surgery playing a limited role in advanced stages. Two main categories of drugs dominate this approach:

•    Tyrosine Kinase Inhibitors (TKIs): These drugs target specific proteins involved in tumour growth and blood vessel formation. Sunitinib and Pazopanib are the established TKIs in India, demonstrating good efficacy in controlling the disease.
•    Immune Checkpoint Inhibitors (ICIs): These drugs harness the body's immune system to fight cancer cells. Pembrolizumab and Nivolumab are prime examples of ICIs, showing improved patient survival compared to TKIs alone.

The optimal treatment for mRCC depends on various factors, including:

•    Patient characteristics: Age, overall health, and presence of other medical conditions are crucial considerations.
•    Tumor characteristics: The size, tumour type, location, and genetic makeup of the tumour influence treatment decisions.
•    Risk factors: Factors like performance status (ability to perform daily activities) and presence of specific mutations in the cancer cells guide treatment choices.

The high cost of newer immunotherapies like pembrolizumab/Avelumab and nivolumab poses a significant challenge in India. Studies suggest that while these combinations show promise, their cost-effectiveness compared to TKIs requires further evaluation. Additionally, access to advanced diagnostic testing to identify patients who might benefit most from specific therapies can be limited in certain regions.

Emerging Frontiers

The field of mRCC treatment continues to evolve, with promising new avenues emerging:

•    Combination therapies: Combining TKIs and ICIs or other targeted agents is being explored to potentially improve outcomes further.
•    Targeted therapies: Drugs that target specific mutations in cancer cells offer a personalised approach with potentially fewer side effects.
•    Gene therapy: This approach involves introducing genetic material to alter cancer cells or boost the immune response and holds promise for the future.

Importance of Clinical Trials

Clinical trials play a crucial role in advancing treatment options for mRCC. Participation in these trials allows Indian patients access to cutting-edge therapies and contributes valuable data to improve treatment strategies for the local population.

The landscape of mRCC treatment in India is transforming. Established therapies like TKIs offer good disease control, while newer immunotherapies show promise for improved survival. However, cost considerations and access to advanced diagnostics remain hurdles. Exploring combination therapies, targeted agents, and gene therapy holds promise for the future. Ultimately, a collaborative effort involving oncologists, researchers, and policymakers is vital to ensure effective and accessible treatment options for all mRCC patients in India.
 

The author is Senior Director, of Medical Oncology, Cancer Care, Medanta, Gurugram

Dr. Kunjahari Medhi

Guest Author