A combination therapy has shown powerful anticancer responses in patients with a type of advanced kidney cancer in a new international phase III clinical trial (KEYNOTE-426). Treatment with the combination therapy resulted in significant increases in overall survival when compared with the current standard of care, and the findings will help to provide a vital new treatment option for patients with this disease.

In the trial, co-led by Professor Thomas Powles from our Centre for Experimental Cancer Medicine, 861 patients with previously untreated clear-cell metastatic renal cell carcinoma (mRCC) were given either a combination of pembrolizumab and axitinib or the current standard therapy, sunitinib.

Treatment with the combination therapy was associated with a 47% reduction in the risk of mortality compared with the current standard therapy. Improvements in progression-free survival and overall response rate were also observed following treatment with pembrolizumab and axitinib.

The KEYNOTE-426 trial, funded by Merck Sharp & Dohme, built upon the results of an earlier phase Ib trial, which showed pembrolizumab and axitinib to have promising anti-tumour activity and a manageable safety profile in patients with mRCC.

Pembrolizumab is a type of immunotherapy drug known as an immune checkpoint inhibitor, which binds to a protein called PD-1 on the surface of immune cells. By blocking PD-1, pembrolizumab triggers immune cells to locate and kill cancer cells.

Axitinib and sunitinib are known as antiangiogenic treatments and work by inhibiting the formation of new blood vessels in cancer cells. Blood vessel formation, called angiogenesis, is an essential process for cancer growth.

A major step forward for kidney cancer

Speaking about the findings of the KEYNOTE-426 trial, Professor Powles said:

"These results are exciting. Overall, we have not previously seen a renal cancer study which has improved response, progression-free survival, and overall survival. This is therefore a major step forward in renal cancer."

Kidney cancer is the 7^th most common cancer in the UK, with 12,600 new cases diagnosed each year, and renal cell carcinoma is the most common type of kidney cancer, accounting for over 80% of the kidney cancer cases diagnosed in the UK. Survival rates for metastatic kidney cancer, when the disease has spread to other parts of the body, are low.

Professor Powles will be presenting the results of the KEYNOTE-426 trial at the 2019 Genitourinary Cancers Symposium in San Francisco, California this Saturday, 16^th February. View the full abstract here.