Treatment selection for metastatic kidney cancer based on gene expression

The discovery of a reliable biomarker for metastatic renal cell carcinoma (RCC) to predict response to treatment has been difficult to identify. This study was presented at the European Society of Medical Oncology (ESMO) Virtual Congress in September this year. The interview started by describing the currently used scoring systems used to categorise patients into poor, intermediate and favourable risk groups for treatment (MSKCC and IMDC), both based on clinical and pathological features of the patient. The interview then moves on to discuss the results of the BIONIKK study with first-line nivolumab versus nivolumab and ipilimumab versus either sunitinib or pazopanib.

Patients with certain types of genes could help to predict how the patient would respond to treatment. The study looked at 35-genes from the tumour tissues and identified four different gene ‘signatures’, which could help to predict how patients would respond to single immunotherapy, double immunotherapy or tyrosine kinase inhibitors (TKIs).

The system has yet to be tested for routine clinical use. But nonetheless, it is a very important study because it proves two points: that a biomarker-driven study in metastatic RCC is possible, and that we may finally have a predictive biomarker that is better than PD-L1 or any of the other biomarkers that we’ve been exploring in RCC to help guide treatment. More biomarkers are being investigated, and are eagerly anticipated.

Read more in Practice Update here

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