Combining Nephrectomy and SBRT for Advanced Kidney Cancer
Pairing nephrectomy with stereotactic body radiation therapy (SBRT) may prove to be an effective treatment for patients with metastatic renal cell carcinoma, based on the early findings of a pilot study conducted by researchers at Roswell Park Cancer Institute in Buffalo, New York and published in Clinical Cancer Research. Lead authors Anurag K. Singh, MD; Thomas Schwaab, MD, PhD; and Jason Muhitch, PhD, consider this the first clinical trial to evaluate the immune effects of high-dose radiation therapy followed by surgery in this patient population.
Fourteen patients with metastatic renal cell carcinoma were given SBRT in a single fraction; then 4 weeks later, they underwent cytoreductive nephrectomy. Patients’ tumors were monitored for expression of immunomodulatory molecules and tumor-associated antigens.
The investigators found that SBRT-treated tumors had an increased expression of the immunomodulatory molecule calreticulin and the tumor-associated antigens CA9, 5TA, NY-ESO-1, and MUC-1.
Although patients with this type of cancer are not routinely treated with both high-dose radiation and surgery, Dr. Muhitch noted the trial gave them the unique opportunity to assess the intratumoral immune landscape in patients after radiation therapy. Dr. Schwaab added: “Our findings provide a striking rationale for looking into even broader combination treatment strategies incorporating not just radiation and surgery but also immunotherapy.”
Findings from this pilot study will be presented at the upcoming American Society for Radiation Oncology (ASTRO) Annual Meeting in San Diego in September, where Dr. Singh will receive a Basic/Translational Science Abstract Award for his role in this work.