Immunotherapy and targeted therapies for the treatment of kidney cancer have advanced the field in recent years, according to Sunil Sudarshan, MD. This is especially true for patients with advanced kidney cancer.
As the treatment landscape continues to evolve, there are other opportunities for precision medicine that investigators have yet to explore, said Sudarshan, professor, department of urology, Heersink School of Medicine, University of Alabama. . One potential breakthrough is the introduction of new immune checkpoint inhibitors. Additionally, Sudarshan sees the potential to target the epigenome in kidney cancer patients.
In an interview with Targeted Oncology ™ following the 2021 International Kidney Cancer Symposium, Sudarshan discussed the kidney cancer paradigm and opportunities to advance the field with new targets.
TARGETED ONCOLOGY ™: What’s in the Kidney Cancer Oncologist’s Toolkit Currently?
Sudarshan: I would say that the landscape for kidney cancer, especially advanced disease, has changed dramatically since my training. It was around this time that targeted therapies were first introduced to the field. My personal take on how patients with advanced kidney cancer have really changed. He has become much more optimistic. This is probably due in large part to advances in immunotherapy. I think this has really changed the game in recent years.
At the same time, we have a lot of loopholes. During IKCS 2021, James P. Allison, PhD, gave a presentation where he alluded to some of these shortcomings, including the fact that not all patients respond. A significant proportion of patients do not have lasting responses, even if they do have an initial response. And we really don’t know what these factors are that contribute to sensitivity or response. I think we need to focus on trying to elucidate those factors, to really try to improve therapies for patients.
Another important thing is the lack of robust models to test some of these hypotheses. I think it’s something that we really have to work on to try to develop and get out. Thus, some of the efforts that the Kidney Cancer Association has funded and attempted to support in terms of developing SIND genetic models are relevant models of kidney cancer, which are immunocompetent. I am optimistic that these efforts can lead to accelerate these discoveries.
With clinical research in mind, what are the major renal cell carcinoma (RCC) research topics currently?
I think we’re really trying to find out what the best rational therapy combinations and sequences are. So some of the broader genome-wide approaches will hopefully provide new perspectives in terms of immunotherapies, because I think there are some of the approved checkpoint therapies out there. But as we heard at IKCS 2021, some of the keynote speeches, there are other immune checkpoints worth exploring. So I think investigating some of these other checkpoints and whether they could perhaps synergize with currently approved therapies is a real opportunity.
What other unmet needs do you think are important to highlight?
Being from the South and practicing in a strongly African American population, I think there are a lot of disparities worth pointing out. And really, we have to go deeper into them. For example, if you look at the very first level of histology, the histological makeup of African Americans is very different from that of Caucasians. Another very clear example is the incidence of VHL Mutations in African Americans with kidney cancer are very different from those in Caucasians. So I think we really need to know that there are these disparities and that there are opportunities to shed light on new biologies, as well as to improve therapies in a much more targeted way as we uncover these differences. and what are their biological effects. the importance are.
What excites you about the future of kidney cancer treatment?
I’m excited about some of the metabolic information that is emerging on kidney cancer, in regards to the oxidation of glucose including metabolism, I think it has been. These are some of the revolutionary studies. And I think what I really learned was knowing the level of coordinated effort it takes between basic researchers, translational researchers, clinicians, and the clinical research infrastructure to make these things happen. produce in a very coordinated and transparent manner. We see the end product, and we really don’t see everything it took to get there. So I think there was really an appreciation for a lot of these layers that maybe don’t come out in the final product. Also, the people who really contribute to this process have really set a roadmap for many of us who are interested in various aspects of metabolism or basic biology and maybe have tried to incorporate some of these. patient-centered models in our own research programs.
When it comes to immunotherapy, I think we are all very excited about immunotherapy. But there are other opportunities. Kidney cancer is the first for agents that may target the epigenome. Perhaps these can also interact with immunotherapy. I think overall there are opportunities out there that we need to explore, cultivate, and provide for investigators looking at them.