One-third of diagnosis of the tumor to the kidney is in an advanced stage, but with the immuno-oncology, and therapeutic approach that aims to awaken the immune system to fight the cancerous cells, the 39% of the patients alive at 3 years
In 2017 in Italy are estimated to be 13.600 new cases of cancer of the kidney, with a marked difference in geographic incidence. The disease is most striking in the North of our Country: this year it is estimated that the new cases encountered in the south are 43% less) among men and 40% among women compared with the North.
The greater consumption of fresh fruit and vegetables, typical of the mediterranean diet, which is widespread in the South, protects from the risk of onset of cancer. Today, there are new weapons in the fight against kidney cancer. The immuno-oncology has shown important positive results, allowing you to check how long the disease even in the metastatic, improving the survival with a good quality of life. In particular, nivolumab is the first molecule immuno-oncology to demonstrate a survival benefit in patients previously treated: 39% alive at 3 years compared to 30% of those who received everolimus (therapy target). Moreover, the rate of objective response, 36 months, has reached 26% with nivolumab compared to 5% of the therapy target. “The updated data to 36 months of the study CheckMate -025 on 803 patients, which has led to the approval of the molecule to April 2016 in Europe and February 2017 in Italy, confirm the effectiveness of the immuno-oncology – explains prof.
Giacomo Cartenì, Director of Medical Oncology of the Ospedale Cardarelli in Naples -.
. Are really important results. It should also be considered that the percentages in three years, the company has achieved thanks to immuno-oncology, tend to remain in the long term, as illustrated by the data of survival in other tumor types, such as melanoma. The objective is to arrive in a short time the personalization of treatment that is more and more articulated thanks to the continuous innovations in the biological knowledge of the disease”. Today in our Country there are about 130 thousand people with the diagnosis of this tumor, a figure that has increased by 31% in eight years (2010 – 2017). Renal cell carcinoma clear cell is the type to head higher and constitutes 80-90% of the total cases. “There are several risk factors associated with the onset of this malignancy,” says the prof. Camillo Porta of Medical Oncology, IRCCS Foundation, Policlinico ‘San Matteo’ of Pavia, in particular smoking, high blood pressure and occupational exposure to carcinogenic chemicals.
A further major risk factor is attributed to being overweight, which can be traced back 25% of the diagnoses: a worrying if we consider that the 31,7% of Italian over 18 is overweight and 10.
For this, the fight against kidney cancer starts from prevention and a key role is played by awareness-raising campaigns and information”. About 60% of renal neoplasms is not identified randomly, as a direct result of the use, increasingly widespread, of diagnostic imaging. “One-third of patients, however, comes to the diagnosis of advanced-stage metastatic and in a third, the disease develops in the form metastatic after surgery with limited treatment options,” continues the prof. . Cartenì -. . Then only 30% of the cases healed by the surgery alone.
In kidney cancer, the chemotherapy and radiotherapy have proven to be, historically, are not very effective”.
“Important perspectives – prof.
Door – you are opening up thanks to the combination of the molecules in immuno-oncology. The combination of nivolumab and ipilimumab has shown in the first line (that is, in patients not previously treated) an improvement of clinical benefit compared to standard of care (sunitinib), with a reduction in the risk of death by 37%.
. Not only. The progression-free survival has reached 11,6 months with the combination compared to 8. .4 months with sunitinib”. The figure emerges from the study of the phase III CheckMate-214, which involved 1082 patients with renal cell carcinoma advanced pretreated.
This study was stopped prematurely last September because it has reached the purposes: the combination of nivolumab and ipilimumab has shown an overall survival greater than sunitinib, in patients at intermediate risk and unfavorable. In addition, further exploratory analysis of the study in subgroups with different expression of the marker PD-L1 has confirmed that the combination of the two molecules is able to improve survival independently from the levels of PD-L1, with an advantage in the control of the symptoms of the disease. The european medicines agency (EMA) has recently validated the application for a variation of nivolumab in combination with ipilimumab for adult patients with intermediate-risk/unfavorable renal cell carcinoma.