The two-pronged attack that gives kidney cancer patients new lease of life
PEOPLE with advanced kidney cancer are living longer, healthier lives thanks to a new ‘two-pronged attack’ drug treatment. The combination of axitnib and avelumab is now available on the NHS in England, after health regulator the National Institute for Health and Care Excellence gave the green light last month.
Axitnib, a twice-daily tablet, restricts blood supply to tumours, causing them to die off. Patients also have a once-fortnightly immunotherapy drug, avelumab, given via a drip, which encourages the body’s immune system to attack and kill cancerous cells.
A large international trial has already found that the combination, developed by drug companies Merck and Pfizer, is more effective than the current standard treatment, halting the growth of tumours for months longer. Experts hope the approach could add years to patients’ lives.
Colin Armstrong, 68, from Glasgow, is one of those who took part in the trial. He was diagnosed with kidney cancer in July 2017, having suffered exhaustion and night sweats, and dropping from 14st to 9st.
A scan revealed a huge 7in-long tumour in his right kidney and cancerous lesions in his lungs. Because his cancer had spread, he was not considered suitable for surgery.
Instead, he was immediately enrolled in a trial of the new combination therapy, and in August 2017 began treatment.
Today, his lungs are clear and the tumour in his kidney has more than halved in size.
Astonishingly, despite his initial bleak prognosis, he will soon have surgery and could be left cancer-free. Mr Armstrong says he feels ‘back to full health and strength’.
ABOUT 13,000 people in the UK are diagnosed with kidney cancer every year. The disease can be difficult to detect, causing few symptoms until it is advanced. Figures show that more than four in ten patients find out they have it at a late stage, when treatment options are limited.
This month, it was announced that Tony Morris, the long-standing presenter of ITV’s Granada Reports, had died from the disease at the age of 57, just a year after he was first diagnosed.
The most common type of kidney cancer is renal cell carcinoma, which accounts for more than eight out of ten cases in adults. In advanced cases, when the cancer has spread beyond the kidney, chemotherapy and radiotherapy are not very effective.
Typically, patients are treated with a handful of drugs that slow the growth of the tumour. However, they do not work for some, and in many others become less effective over time.
‘For the vast majority of patients, the cancer learns how to avoid the drugs and becomes resistant,’ Dr Paul Nathan, a consultant medical oncologist at Mount Vernon Cancer Centre in Hertfordshire, explains. ‘We cycle through different tablets and then we reach a point where, for many patients, the cancer no l onger responds and i t grows uncontrollably and they die.’
The newly approved treatment for advanced renal cell carcinoma could help an estimated 1,600 people in England every year.
The results of a study into the combination, called the Javelin Renal 101 study, suggest that patients live for five months longer without their cancer progressing than those given the standard treatment, a targeted therapy called sunitinib. In the study, double the number of patients saw t heir tumours shrink.
It is too soon to say whether the treatment has the potential to cure advanced renal cell carcinoma, Dr Nathan says, as more long-term data is needed. But he adds: ‘I’m in no doubt there is a group of patients who will have such long-term control of their cancer that they will die in old age from something else. They will get more time with their families, more time to work and to be an active, contributing member of society.’
A separate immunotherapy treatment, nivolumab, was previously approved by the health regulator for use in patients in England with advanced kidney cancer. However, this can help only those with the most aggressive form of the disease. ‘This new combination appears to be beneficial across the board,’ Dr Nathan says. ‘It gives us more options.’
Mr Armstrong, a former court clerk, first visited his doctor after suffering six weeks of night sweats, weakness in his limbs and then inexplicable weight loss. ‘I was anticipating bad news, and I was initially a bit reluctant to go,’ he says. ‘But eventually I went and it’s just as well.’
He was not suitable for surgery, but was offered a place on the trial. ‘I started to feel better within weeks,’ he says.
But taking axitnib and avelumab has not been totally straightforward. He suffered side- effects, including chronic diarrhoea and hand-foot syndrome, a condition that develops when medication leaks out of the blood vessels in the palms of the hands and soles of the feet, causing damage to the surrounding tissue.
But scans showed the drug combination was working: lesions in his lungs were disappearing and the tumour was shrinking. Three years later, the tumour has reduced in size by 60 per cent.
RECENT scans showed part of his tumour is starting to grow, so doctors now plan to operate in the coming months, removing the growth and his kidney. This will, they hope, leave him cancer-free.
On the whole though, Mr Armstrong feels well.
‘I can do pretty much all that I could do before diagnosis,’ he says. ‘I walk and drive as before, and though I’m not doing as much DIY now, I’d say I’m back to full health and strength.’
Nick Turkentine, chief executive of Kidney Cancer UK, says: ‘Kidney cancer is the seventh most common cancer in the UK and often diagnosed at a late stage.
‘Statistics show that survival rates are poor following a late diagnosis which leaves patients with limited treatment options. There is an urgent need to improve outcomes, and advances in cancer treatment, such as this, provide a lifeline for patients and families.’