Dr Ahluwalia on the Incidence of Brain Metastases in RCC

Manmeet Ahluwalia, MD, MBA, FASCO, chief, Medical Oncology, chief scientific officer, deputy director, Fernandez Family Endowed Chair in Cancer Research, Baptist Health Miami Cancer Institute, discusses findings from a National Cancer Database analysis of treatment outcomes in patients with brain metastases from primary renal cell carcinoma (RCC).

Notably, these data were shared at the 2024 ASCO Annual Meeting. As kidney cancer treatment outcomes have improved, the brain has emerged as site of concern, as there has been an increasing incidence of brain metastases in patients with kidney cancer, Ahluwalia begins. Currently, kidney cancer ranks as the fourth most common cancer to metastasize to the brain, following lung cancer, breast cancer, and melanoma, he explains. Predicting the exact proportion of patients with kidney cancer who will develop brain metastases is challenging, but it is estimated to be approximately 10% to 15% of those with stage IV disease, he notes.

Traditionally, treatment for patients with brain metastases has involved radiation, whether it be whole brain radiation or focused forms, such as stereotactic radiosurgery, he expands. A large national database has shown that patients with RCC who received both radiosurgery and immunotherapy had the best outcomes, with a median overall survival (OS) of 19.0 months compared with an OS of 9.7 months in 25.15% of patients who received only stereotactic radiosurgery, Ahluwalia reports. This makes the combination of radiosurgery and immunotherapy the preferred treatment for these patients, he shares, adding that this approach aligns with findings in other cancers, such as lung cancer, where combining immunotherapy with radiosurgery has proven highly effective.

Mechanistically, combining radiosurgery with immunotherapy makes sense because radiosurgery increases the expression of new epitopes, acting as a sensitizer for immunotherapy and enhancing the immune response, he elucidates. This combination has elicited better outcomes in patients than either treatment alone, a trend also observed in patients with lung cancer and melanoma brain metastases, Ahluwalia concludes.