New Hope After Kidney Cancer Surgery: How Immunotherapy Is Changing Lives

Kidney cancer, also called renal cell carcinoma, is a disease where abnormal cells grow in the kidney—a bean-shaped organ that filters waste from our blood. For many patients, the first step is surgery to remove the tumor (called a nephrectomy). But for those with high-risk features—like larger tumors, cancer that has spread to nearby lymph nodes, or aggressive cell types—there’s a real worry that the cancer might come back, even after a successful operation.

Traditionally, after surgery, patients were closely monitored with scans and blood tests, but there was no proven way to lower the risk of the cancer returning. This left many patients and families anxious, wishing there was something more they could do.

The KEYNOTE-564 trial was a major international study that asked: Can we help the body’s own immune system prevent kidney cancer from coming back after surgery?

The answer came in the form of pembrolizumab, a type of immunotherapy. This medicine works by “releasing the brakes” on the immune system, helping it recognize and attack any remaining cancer cells—like giving your body’s security guards a better way to spot troublemakers.

In the KEYNOTE-564 trial, nearly 1,000 patients who had their kidney tumors removed—and were at high risk for recurrence—were randomly chosen to receive either pembrolizumab or a placebo (a look-alike treatment with no active drug).

The results, now with five years of follow-up, are truly encouraging:

• Lower Risk of Cancer Coming Back: After five years, about 61 out of 100 patients who received pembrolizumab remained cancer-free, compared to only 52 out of 100 who received the placebo. This means pembrolizumab reduced the risk of the cancer returning by nearly 30%.
• Better Survival: More patients were alive at five years—nearly 88% with pembrolizumab, compared to 82% with placebo.
• Works Across Risk Groups: The benefits were seen in all types of high-risk patients, including those with more aggressive cancer features like “sarcomatoid” features.
• Good Safety Profile: Most patients tolerated the treatment well, and there were no new or unexpected side effects even after several years .

If you or a loved one has had kidney cancer surgery and your doctors say you’re at high risk for recurrence, pembrolizumab after surgery (called adjuvant therapy) could offer real hope:

• A better chance of staying cancer-free
• Longer survival
• A treatment that’s generally well-tolerated
• Peace of mind knowing there’s something more you can do after surgery

Imagine finishing your surgery and, instead of just waiting and worrying, being able to “turn on” your body’s own defences to keep the cancer at bay.

No treatment is perfect. Pembrolizumab, like all immunotherapies, can sometimes cause the immune system to attack healthy organs, leading to side effects such as fatigue, skin rashes, diarrhea, or, rarely, more serious problems with organs like the lungs or liver. However, these are usually manageable with prompt medical attention, and no new long-term risks were seen over five years in the trial .

Also, immunotherapy can be expensive, and not every patient will be eligible. It’s important to have a detailed conversation with your oncology team to weigh the potential benefits and risks for your individual situation.

This article is for educational purposes and reflects the patient-focused, innovative spirit of Dr. Sandeep Nayak and Dr. Suresh Babu at MACS Clinic, Bangalore. Always consult your healthcare provider for advice tailored to your unique situation.