Advances in Kidney Cancer Research
NCI-funded researchers are working to advance our understanding of how to detect and treat kidney cancer. Much progress has been made over the last few decades, especially in identifying genes that can drive the development of kidney cancer. This knowledge has led to more effective treatments. Today, about 75% of people with kidney cancer will be alive 5 years after diagnosis.
This page highlights some of the latest research in kidney cancer, including clinical advances that may soon translate into improved care, NCI-supported programs that are fueling progress, and research findings from recent studies.
Early Detection of Kidney Cancer
Liquid Biopsies to Detect Small Kidney Cancers
No screening test currently exists that can diagnose kidney cancer early, before symptoms develop. Researchers are trying to develop blood or urine tests—sometimes called liquid biopsy tests—to detect small kidney cancers.
A recent study found that one of these tests, which analyzes DNA shed by kidney tumors, could distinguish with about 99% accuracy whether blood samples had been taken from people with or without kidney cancer. It was also 86% accurate at detecting kidney cancer in urine samples, which are easier to collect than blood samples.
More research is needed to confirm these findings, and to improve the test’s performance in urine samples. Scientists hope that tests of this type could eventually be used to screen people who are at high risk of developing kidney cancer, such as those with certain inherited conditions. These tests might also be used for tracking response to treatment and monitoring for cancer recurrence.
Genetic Testing for Kidney Cancer Risk
About 5% to 8% of kidney cancers are caused by inherited genetic changes. Fourteen different hereditary syndromes increase the risk of kidney cancer (and sometimes other cancers). The gene changes that cause these syndromes have been identified, and people who have a history of kidney cancer in their family can now undergo genetic testing to see if they carry any of these changes. This information can help their health care providers develop a personalized plan for monitoring kidney health.
Kidney Cancer Treatment
Until a few decades ago, kidney cancer was considered to be a single disease. But that changed after the first gene linked to kidney cancer, called the VHL gene, was discovered at NCI in the 1990s. Alterations in this gene can be inherited (in people with Von Hippel-Lindau disease), or they can arise during someone’s lifetime.
Since this discovery, researchers have come to recognize that kidney cancer is many different diseases, each driven by distinct genetic features. This work has led to the development of many targeted therapies for kidney cancer. Ongoing research is working to further personalize targeted treatments and to tease out the role of immunotherapy in kidney cancer treatment.
Targeted Therapies for Advanced Kidney Cancer
Clear-Cell Kidney Cancer
The most common type of kidney cancer is clear-cell renal cancer. VHL is the most commonly altered gene in that cancer type. The VHL protein normally blocks tumor development. However, when it is altered or missing, tumors can grow. Several drugs that target the VHL gene pathway have been approved by the FDA to treat clear-cell kidney cancer.
Researchers are continuing to investigate new treatments that target the VHL pathway. For example, clinical trials are testing drugs that shut down a protein in the VHL pathway called HIF-2α.
- One study found that a drug called belzutifan, which blocks HIF-2α, shrank clear-cell kidney tumors in people with Von Hippel-Lindau disease. These responses to treatment were long-lasting.
- Other studies are also testing belzutifan in combination with other targeted therapies and with immunotherapy drugs.
Rare Kidney Cancer Types
About 15% of people with kidney cancer have papillary renal cell carcinoma, or PRCC. It is thought to start in a different kind of cell than clear-cell kidney cancer. Data from The Cancer Genome Atlas and other research efforts have shown that some cases of PRCC are driven by changes in a gene called MET. Examples of studies for rare kidney cancer include:
- Based on the discovery of the MET gene, researchers compared cabozantinib (Cabometyx), which targets MET, with sunitinib (Sutent) in the first large randomized trial ever completed in this rare cancer type. People with advanced PRCC who were given cabozantinib lived about 50% longer without their disease progressing than people who received sunitinib.
- In 2020, an NCI research team found that people with one known subtype of hereditary PRCC had strong responses to treatment with the drugs bevacizumab (Avastin) and erlotinib (Tarceva), which target changes specific to that subtype. In that small clinical trial, those patients lived for a median of almost 2 years without their disease progressing. Work is ongoing to better personalize treatment in this rare disease.
Immunotherapy for Advanced Kidney Cancer
Immunotherapy has become a major focus of kidney cancer treatment research. Today, most people with advanced kidney cancer will receive a type of immunotherapy drug called an immune checkpoint inhibitor at some point during their treatment.
A small minority of people with clear-cell kidney cancer and other, rarer types of the disease have their tumors disappear entirely during treatment with these drugs. Studies are under way to uncover characteristics of patients or tumors that make immunotherapy more likely to work. And combinations of immunotherapies or of immunotherapies plus targeted therapies have been approved or are being studied in trials.
- Two combinations of a targeted therapy plus an immune checkpoint inhibitor have been approved for people with advanced kidney cancer:
- Pembrolizumab (Keytruda), plus the targeted drug axitinib (Inlyta)
- Nivolumab plus cabozantinib
- Ongoing trials are testing other combinations of immune checkpoint inhibitors and targeted therapies, in clear-cell kidney cancer as well as PRCC and other rare types of kidney cancer.
To date, studies have not compared existing immunotherapy combinations directly, or tested whether these drugs work better when given together than given sequentially.
Treatment of Kidney Tumors in Children
Although rare, kidney cancer can develop in children and adolescents. The most common type of kidney cancer in children is called Wilms tumor.
Treatment with the combination of surgery, radiation therapy, and chemotherapy has increased 5-year survival rates for children with all stages of Wilms tumor from 40% in the 1950s to nearly 90% today.
But this intensive treatment can have serious or even fatal long-term side effects, including second cancers and scarring of the lungs. So researchers are now testing whether less-intensive treatment regimens can maintain the high survival while reducing side effects. For example:
- An NCI-sponsored clinical trial, led by the NCI-funded Children’s Oncology Group (COG), found that some children with advanced Wilms tumor may be able to skip radiation therapy entirely.
- Another COG trial found that some young children with small Wilms tumors at low risk of recurrence can safely have surgery alone, without chemotherapy.
The COG also conducts studies of rarer types of childhood kidney cancer. One COG study is currently testing targeted therapy and immunotherapy for a rare type of kidney cancer in children called translocation renal cell carcinoma (tRCC). This study is also enrolling adult patients with this rare cancer.
NCI-Supported Research Programs
See the full list of kidney cancer research projects that NCI funded in FY 2018.
Many NCI-funded researchers working at the NIH campus, as well as across the United States and throughout the world, are seeking ways to address kidney cancer more effectively. Some research is basic, exploring questions such as the biological underpinnings of cancer. And some is more clinical, seeking to translate this basic information into improving patient outcomes. The programs listed below are a small sampling of NCI’s research efforts in kidney cancer.
- NCI’s Kidney Cancer Specialized Programs of Research Excellence (SPOREs) promote collaborative, interdisciplinary research. SPORE grants involve both basic and clinical/applied scientists working together. They support the efficient movement of basic scientific findings into clinical settings, as well as studies to determine the biological basis for observations made in individuals with cancer or in populations at risk for cancer.
- NCI's National Clinical Trials Network (NCTN) is a collection of organizations and clinicians that coordinates and supports cancer clinical trials at more than 3,000 sites across the United States and Canada. NCTN currently has a variety of trials testing treatments for kidney and other genitourinary cancers.
- NCI has also formed partnerships with the pharmaceutical industry, academic institutions, and individual investigators for the early clinical evaluation of innovative cancer therapies. The Experimental Therapeutics Clinical Trials Network (ETCTN) was created to evaluate these therapies using a coordinated, collaborative approach to early-phase clinical trials. The ETCTN is currently running early-stage trials in kidney and other genitourinary cancers.
- NCI’s Division of Cancer Epidemiology and Genetics (DCEG) conducts studies on kidney cancer to learn about risk factors for the disease. Some of their areas of study are described in these kidney cancer research studies.
- As part of the Cancer Moonshot℠, the Approaches to Identify and Care for Individuals with Inherited Cancer Syndromes initiative seeks the best approaches to identify people with an inherited cancer syndrome—including syndromes that can increase the risk of kidney cancer—and provide appropriate follow-up care.
Kidney Cancer Research Results
The following are some of our latest news articles on kidney cancer research:
- Belzutifan Approved to Treat Tumors Linked to Inherited Disorder VHL
- Targeted Therapy Cabozantinib Slows Progression of Rare Kidney Cancer
- Liquid Biopsy Detects Brain Cancer and Early-Stage Kidney Cancer
- Targeted Therapy–Immunotherapy Combinations Effective for Advanced Kidney Cancer
- Some Children with Wilms Tumor Can Receive Less Therapy, Study Suggests
- FDA Approves Nivolumab and Ipilimumab Combination for Advanced Kidney Cancer
View the full list of Kidney Cancer Research Results and Study Updates.