Navigating Immune-Related Adverse Effects During Kidney Cancer Therapy

Immune-related adverse effects (AEs) represent a “double-edged sword” in the management of kidney cancer, according to David Braun, MD, PhD.

In a visit to Yale Cancer Center, CancerNetwork® spoke with Braun about strategies for overcoming immune-related toxicities among patients undergoing treatment for renal cell carcinoma, and how these events may show prognostic potential in this population.

On one hand, Braun stated, the presence of immune-related AEs demonstrate that the immune system is waking up during treatment, as some studies have shown a link between these toxicities and more favorable cancer-related outcomes. On the other hand, these immune-related AEs may result in hospitalizations or life-threatening complications, necessitating research to determine which patients are most at risk of experiencing these toxicities.

Braun is an assistant professor at Yale School of Medicine and principal investigator in the Center of Molecular and Cellular Oncology within the Yale Cancer Center.

Transcript:

Immune-related AEs in kidney cancer are a bit of a double-edged sword because when you think of what current immune therapies are meant to do, they are essentially lifting the brake on the immune system. For them to be successful, there are essentially 2 broad steps that have to happen. The immune system has to wake up, and then that awakened immune system has to effectively find and target the kidney cancer cells. In some ways, an immune-related AE is at least an indication that step 1 is happening, that at least the immune system is waking up. That’s why, in larger studies, there is often this association between having immune-related AEs and having more favorable cancer-related outcomes because it’s that sign of at least immune therapy doing its first job. It’s reawakening the immune system. That’s the positive side of it.

Obviously, the negative side is that these can be devastating for our patients. They range, of course, from relatively treatable and minor things to things that induce a lot of hardships, including hospitalizations to sometimes even lifelong or life-threatening complications. There’s a lot of work that needs to be done to understand who the patients are most at risk for immune-related AEs and then, frankly, [the] strategies that might be effective in mitigating these, even preventively. Here at Yale, there are numerous studies within our skin and kidney cancer group that are exploring that: what are the determinants of immune-related AEs, and what might be early interventions to help overcome them?