Practice Update on Advanced Kidney Cancer - Episode 5

Renal Cell Carcinoma Histologies

The genetics and histologies among renal cell carcinoma (RCC) subtypes are heterogeneous, each representing a unique treatment challenge, states Eric Jonasch, MD. The clear cell histology is generally characterized as an angiogenic tumor with Von Hippel-Lindau mutations. The papillary histology, which is the second most common type of RCC, is characterized by MET upregulation, which is an oncogene found on chromosome 7, says Jonasch.

Traditionally, patients with clear cell RCC respond well to immunotherapy; however, this was largely based on data from studies exploring interferon, notes David F. McDermott, MD. Recent clinical trials have shown that there is a signal of activity with PD-1/PD-L1 inhibition in non-clear cell tumors, suggesting other histologies might also have immunogenic properties.

Clinicians should encourage sponsors of RCC clinical trials to allow the enrollment of patients with non-clear cell histology, notes McDermott. The non-clear cell histology represents approximately 20% of individuals with the disease and effective therapies are needed, notes McDermott.