Editor's Note: Renal cancer is one of the three major malignancies in the urinary system, with advanced metastatic renal cancer having a poor prognosis and an overall five-year survival rate of less than 20%. Recent advances in targeted therapies and immunotherapies have led to significant improvements in treatment outcomes; however, for patients progressing beyond first-line therapies, the quest to extend survival remains an ongoing challenge. At the recently held 8th West China Uro-Oncology Tianfu Academic Conference, Dr. Jun Guo from Peking University Cancer Hospital shared insights into "Future Trends in Cellular Therapy for Renal Cancer," offering new hope for these patients. Following the conference, Oncology Frontier invited Professor Guo to provide further insights.

1. Reviewing Progress in Renal Cancer Treatment: Continuous Improvement in Patient Outcomes

Targeted Therapy

Over the past two decades, renal cancer treatment has witnessed remarkable advancements. For metastatic renal cancer, the introduction of targeted drugs such as sorafenib, sunitinib, pazopanib, and everolimus marked a revolutionary breakthrough, significantly transforming clinical practice.

Immunotherapy

The subsequent advent of immunotherapy further improved patient survival. Therapies such as PD-1 inhibitors, CTLA-4 inhibitors, dual immune checkpoint blockade strategies (combining CTLA-4 and PD-1 inhibitors), and combinations of immune checkpoint inhibitors with targeted drugs (e.g., axitinib combined with PD-1 inhibitors or lenvatinib combined with PD-1 inhibitors) have achieved high response rates in first-line treatment.

Challenges Post-First-Line Therapy

For low-risk renal cancer patients, monotherapy with targeted drugs can still yield satisfactory outcomes. In second-line treatment, immunotherapies also show good efficacy. For intermediate- and high-risk patients, both domestic and international guidelines recommend targeted-immune combination regimens as the first-line choice. These regimens achieve high response rates and significantly prolong progression-free survival (PFS). However, challenges remain for subsequent treatments after disease progression, as ideal therapies that can markedly improve efficacy and extend PFS are still lacking.

2. Looking Ahead: Cellular Therapy Offers Hope for Overcoming the Survival Challenges of Metastatic Patients

Cellular Therapy

Cellular therapy is emerging as a promising research direction to overcome the limitations of current treatment methods. Particularly for patients whose disease progresses after targeted therapy or dual immunotherapy, genetically engineered T-cell therapies such as CAR-T and TCR-T, as well as innovative approaches like CAR-NK, CAR-NT, and CAR-NKT cell therapies, may address the long-term survival challenges following first- and second-line treatment failures. Continuous research and technological innovation offer hope for further improving the prognosis of metastatic renal cancer patients.

Future Outlook

Compared to two decades ago, when the average life expectancy of metastatic renal cancer patients was barely a year, their survival period has significantly improved today, reflecting the tremendous progress in medicine. In the future, with the continuous emergence of more effective and safer treatment options, we are confident that metastatic renal cancer patients will enjoy longer lives and better quality of life.

Dr. Jun Guo

• Chief Physician, Doctoral Supervisor, Director of Melanoma and Sarcoma Medical Oncology and Uro-Oncology at Peking University Cancer Hospital
• Vice President and Secretary General, Chinese Society of Clinical Oncology (CSCO)
• Vice President, International Melanoma Working Group (MWS)
• Chair, Melanoma and Skin Tumors Section, European Society for Medical Oncology (ESMO)
• Chair, Melanoma Committee, National Cancer Center/National Cancer Quality Control Center
• Chair, CSCO Melanoma Expert Committee
• Vice Chair, CSCO Renal Cancer Expert Committee
• Vice Chair, CSCO Immunotherapy Expert Committee
• Vice Chair, CSCO Urothelial Cancer Expert Committee
• Vice Chair, CSCO Prostate Cancer Expert Committee
• Expert Reviewer, National Medical Products Administration (NMPA) Drug Registration
• Member, Anticancer Drug Group, Expert Committee on Rational Drug Use, National Health Commission