Kyle A. Blum, MD, MS, explains how renal medullary cancer, like most rare cancers, can be difficult to study. However, there are several ongoing studies that include this patient population.
Kyle A. Blum, MD, MS, is a urologic surgery resident at The University of Texas MD Anderson Cancer Center. He recently published findings suggesting that CA-125 as a potential predictive biomarker in rectal medullary carcinoma (RMC).
RMC is rare, highly aggressive subtype of renal cancer that typically affects young adults with sickle cell trait. In the United States, most patients are African American and 75% are male, Blum says. The disease accounts for 0.5% to 1% of all renal carcinomas, and the condition was only defined in 1995. Most patients who are not metastatic at diagnosis soon develop metastases. In data reported in 2017, the median survival was 13 months.
Surgery is the primary treatment modality, but the RMC Alliance, a consortium of clinicians, researchers, and patient advocates; calls for consolidative, cytoreductive nephrectomy rather than upfront nephrectomy. Blum says treatments that work for RMC typically do not work for other renal cancers and vice versa.
RMC is an understudied condition, but the investigators have evaluated some treatments for the disease and Blum says he is excited to see the results. MD Anderson recently concluded a phase 2 study of patients with RMC who received nivolumab (Opdivo) and ipilimumab (Yervoy). That study accrued 30 patients, which is a fairly large patient population considering the rarity of this disease, and the study is currently in the data synthesis phase.
MD Anderson is also home for a phase 2 study (NCT05347212) of nivolumab plus relatlimab, a human IgG4 LAG-3-blocking monoclonal antibody that restores the effector function of exhausted T cells. The FDA approved this combination, known as Opdualag, in April 2022 for the treatment of patients with advanced melanoma. Investigators, including Blum, hope that this combination can establish an objective response that might suggest physicians can control RMC in patients with clinically advanced or metastatic disease.
Blum is hopeful to see a dedicated RMC trial with a patient population large enough to produce data that physicians can use when making treatment decisions.