Biomarkers in renal cell carcinoma

Dr Jérémy Blanc, a medical oncologist in training from the Institut Jules Bordet in Brussels, shares the latest information regarding biomarkers in RCC from the oral abstract session at ASCO 2024.

In the CLEAR study, the combination of lenvatinib and pembrolizumab demonstrated significantly improved efficacy compared to sunitinib in treatment-naïve patients with aRCC. Similarly, the KEYNOTE-426 trial exhibited superior efficacy of first-line pembrolizumab plus axitinib over sunitinib in aRCC patients. Biomarker analyses from both studies were presented, encompassing PD-L1 expression, whole-exome sequencing and RNA sequencing. However, the results from these analyses were discordant between the two trials, and no biomarker was identified as sufficiently potent for use in clinical practice.

In the IMmotion010 study, adjuvant atezolizumab did not extend DFS compared to placebo following resection in RCC patients. An exploratory analysis of circulating protein biomarkers was conducted to identify high-risk patients with MRD who might benefit differentially from atezolizumab treatment. Circulating kidney injury molecule-1 (KIM-1) emerged as the most significantly enriched protein at recurrence versus baseline. Outcomes were analyzed in patients with high (≥86 pg/mL) versus low baseline serum KIM-1 levels. High baseline serum KIM-1 levels correlated with poorer prognosis but showed improved clinical outcomes with atezolizumab compared to placebo. Additionally, increased post-treatment KIM-1 levels were associated with worse DFS. These findings suggest that circulating KIM-1 could serve as a non-invasive marker of MRD and disease recurrence, warranting further investigation in the context of adjuvant RCC therapy.