The immunology of renal cell carcinoma

Nat Rev Nephrol. 2020 Dec;16(12):721-735. doi: 10.1038/s41581-020-0316-3. Epub 2020 Jul 30.

Abstract

Renal cell carcinoma (RCC) is the most common type of kidney cancer and comprises several subtypes with unique characteristics. The most common subtype (~70% of cases) is clear-cell RCC. RCC is considered to be an immunogenic tumour but is known to mediate immune dysfunction in large part by eliciting the infiltration of immune-inhibitory cells, such as regulatory T cells and myeloid-derived suppressor cells, into the tumour microenvironment. Several possible mechanisms have been proposed to explain how these multiple tumour-infiltrating cell types block the development of an effective anti-tumour immune response, including inhibition of the activity of effector T cells and of antigen presenting cells via upregulation of suppressive factors such as checkpoint molecules. Targeting immune suppression using checkpoint inhibition has resulted in clinical responses in some patients with RCC and combinatorial approaches involving checkpoint blockade are now standard of care in patients with advanced RCC. However, a substantial proportion of patients do not benefit from checkpoint blockade. The identification of reliable biomarkers of response to checkpoint blockade is crucial to facilitate improvements in the clinical efficacy of these therapies. In addition, there is a need for the development of other immune-based strategies that address the shortcomings of checkpoint blockade, such as adoptive cell therapies.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Biomarkers, Tumor
  • Carcinoma, Renal Cell / immunology*
  • Carcinoma, Renal Cell / therapy
  • Humans
  • Immune Checkpoint Inhibitors / therapeutic use
  • Immune Tolerance
  • Immunotherapy, Adoptive
  • Inflammation / complications
  • Kidney Neoplasms / immunology*
  • Kidney Neoplasms / therapy
  • Myeloid Cells / immunology
  • T-Lymphocytes / immunology
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors

Substances

  • Biomarkers, Tumor
  • Immune Checkpoint Inhibitors
  • Vascular Endothelial Growth Factor A