New combination therapy helps some patients with stage 4 kidney cancer

Michael Szczerbienski had always been in good health, so the day he discovered hematuria, he was very surprised. His doctor sent him for a CT scan, which found a tumor in his left kidney. Michael, who had already advanced kidney cancer, went to Memorial Sloan. was given the opportunity to participate in Thanks to this trial, Michael’s cancer is still in remission, more than three years later.

Michael, now 68, says, “When you have MSK, the people treating you are the best.”

The results of the first clinical trial of its kind were published in the May 11, 2023 issue. New England Journal of Medicine (NEJM). Robert Motzer, MD, Michael’s medical oncologist and MSK kidney cancer expert, was a co-correspondent and senior author of the study.

The trial showed that adding targeted therapy to standard combination therapy for stage 4 kidney cancer was more effective than standard therapy alone. Approximately 87% of patients receiving the new combination had tumor shrinkage or stabilization compared to 55% of patients receiving standard therapy. Additionally, the mean time it took for the disease to progress was 16.9 months in the experimental group compared to 11.3 months in the other group.

The targeted therapy tested was cabozantinib (Cabometyx®), which is already approved to treat kidney cancer alone or in combination with the immunotherapy drug nivolumab (Opdivo®). The study compared the addition of cabozantinib to nivolumab and another immunotherapy agent, ipilimumab (Yervoy®), compared to the combination of immunotherapy compared to placebo. A combination of the two immunotherapies is now also the standard treatment for advanced kidney cancer.

Stage 4 kidney cancer clinical trial adds targeted therapy to immunotherapy

The global Phase 3 study enrolled more than 850 patients. All had stage 4 kidney cancer and were not yet on medication. Some of them had had previous surgery, including Michael, whose tumor was removed by MSK Urological Surgeon Dr. Paul Russo. After surgery, Dr. Russo determined that Michael’s cancer was advanced and needed additional treatment. Dr. Russo introduced Michael to Dr. Motzer, who was able to provide Michael access to clinical trials.

“I remember praying to God when we started the trial that I would be part of the group that was given the additional medication and not the placebo,” says Michael. All results from this study are still blinded. Although unconfirmed, Dr. Motzer is confident that Michael was in the cabozantinib arm because the side effects he experienced were likely related to the targeted therapy.

Research on side effects of new renal cancer drugs

Side effects of Michael’s treatment included pain and severe swelling in his leg. Overall, 45% of people in his experimental group had reactions severe enough to have to stop treatment early. The most common side effects seen in trials were liver problems, skin problems, and gastrointestinal problems such as diarrhea.

Dr. Robert Motzer

Over the past 15 years, Dr. Robert Motzer has developed many new treatments for kidney cancer.

Michael was one of the patients who had to stop taking the drug before the study ended. He is grateful that he was able to receive treatment long enough for his cancer to go into remission.

“It’s too early to tell whether this new combination will become the standard of care because of the serious side effects,” explained Dr. Motzer. “Longer follow-up is needed to see if patients live longer after treatment with the addition of targeted agents compared to standard immunotherapy programs. We focus on determining which ones are most likely to benefit.”

MSK treats Michael’s kidney cancer after it spreads to his brain

About two years after Michael finished treatment in a clinical trial, he began to feel like he was in a mental fog. Eventually, he began to lose control of the left side of his body. An MRI showed that his kidney cancer had spread to an isolated spot on the right side of his brain.In May 2022, MSK neurosurgeon Cameron Brennan had surgery to remove the tumor.

“I wasn’t scared when I had my kidney surgery with Dr. Russo, but this brain surgery was really scary,” recalls Michael. “Dr. Brennan was really great. And it helped me a lot. ”

Michael also needed follow-up radiation therapy to the brain, which was available at MSK Monmouth near his home in New Jersey.

Recovery after brain surgery and radiotherapy was difficult. Michael turned to many of MSK’s care providers, most notably physiotherapist Lauren He Moore, also of MSK Monmouth. In time, he began to feel like himself again.

Michael is doing well after kidney cancer clinical trial

Retired from finance in 2020, Michael remains cancer-free. He enjoys taking walks with his wife, going to his favorite Italian restaurant on the New Jersey coast, and dining out in Manhattan with his two adult sons. He has several trips planned this year, including trips to his two favorite vacation spots, Williamsburg, Virginia and Nantucket, Massachusetts.

“Words cannot express how I feel about MSK.Everyone I met helped make a dire situation bearable,” says Michael. “And Dr. Motzer was the maestro for this entire trip. He took care of me every step of the way.”

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