Korea lags behind global standards in kidney cancer treatment, expert warns

On Thursday, World Kidney Cancer Day, kidney cancer specialists and patient advocacy groups called attention to the poor treatment of kidney cancer in Korea and the urgent need for improvement.

World Kidney Cancer Day has been observed every year on the third Thursday of June since 2017.

At the “Media Seminar to Commemorate World Kidney Cancer Day” held by Ipsen Korea on Tuesday, Professor Park In-keun of the Department of Oncology at Asan Medical Center and Paik Jin-young, head of the Korea Kidney Cancer Association, pointed out that the treatment landscape of kidney cancer -- the ninth to tenth most common cancer in Korea -- differs from that in the U.S., Europe, and other parts of the world.

According to Professor Park, kidney cancer has traditionally been treated with cytotoxic antitumor drugs, with a cure rate of less than 5 percent. Before the introduction of targeted therapies, interleukin and interferon agents had been tried. Currently, cytotoxic anticancer drugs are only used for a rare form of kidney cancer called collecting duct renal cell carcinoma.

Recently, targeted therapies, including Lenvima, Axitinib, and Cabometyx, as well as immuno-oncology drugs such as Opdivo, Yervoy, and Keytruda, have become the mainstay of kidney cancer treatment. Above all, combination therapy—using two or more drugs together—has been proven the most effective.

Accordingly, various drug combinations are used to treat kidney cancer globally, such as targeted therapy+immuno-oncology or immuno-oncology+immuno-oncology. In Korea, four treatment combinations are approved for first-line treatment of kidney cancer: Opdivo+Yervoy, Opdivo+Cabometyx, Keytruda+Lenvima, and Keytruda+Axitinib.

However, in practice, only one of these first-line combinations -- Opdivo+Yervoy -- is reimbursed. “These therapies are available, but only one is reimbursed, which limits treatment options,” Professor Park said.

Opdivo+Yervoy is a highly effective treatment with a high response rate. However, some patients require other options for first-line therapy, but reimbursement issues prevent access to those alternatives.

“If a patient is very symptomatic or has a large mass, we would like to try a combination of targeted therapies and immuno-oncology. But there are many cases where insurance issues prevent us from doing so,” Park said, noting that this situation needs urgent improvement.

Many kidney cancer drugs have been developed recently, but several are not available in Korea because they have not been introduced or are not reimbursed. This has widened the gap between international treatment guidelines and Korea’s clinical reality.

It’s not just a matter of first-line options. Second-line kidney cancer treatment in Korea also lags behind the U.S. and Europe.

“In recent years, the global concept for second-line treatment is to ‘use whatever has been proven effective,’” Park said. “In the U.S. guidelines, all available options are included, and even for combination therapy, the principle is ‘use anything that hasn’t been used before,’” he added.

According to specialists, the reality of second-line treatment in Korea hasn’t changed much in the past 20 years.

“It’s a little sad to see the insurance standards here. Torisel isn’t mentioned in the U.S. or European guidelines, but it’s still reimbursed in Korea. Avastin + interferon is also reimbursed, but patients must pay the full cost of Avastin. Nothing has changed since the early 2000s,” Professor Park said.

Reimbursement for newer kidney cancer drugs is also limited. While clear cell carcinoma, the most common type, has some reimbursement options, non-clear cell carcinoma often has none. “Opdivo is only available for intermediate- or high-risk clear cell renal cancer,” Park noted. “Afinitor is also only reimbursed for clear cell carcinoma.”

Even when a drug is approved as a second-line treatment, reimbursement is dependent on what was used in first-line treatment. For instance, Cabometyx is only reimbursed as a second-line option if a targeted therapy was used first—something not reflected in international guidelines.

“There is a clear need for Cabometyx in cases with bone metastases. However, if patients fail Opdivo+Yervoy and develop bone metastases, they must pay the full cost for Cabometyx,” Park said. “International guidelines allow its use regardless of previous treatment, but Korea’s reimbursement system restricts this.”

Park emphasized that kidney cancer drug treatment has improved significantly, but domestic policies still hinder drug choices. He urged swift changes to align treatment with current advancements.

Patient groups shared similar concerns.

“There are so many kidney cancer drugs, and most are reimbursed overseas,” Paik said. “We hear about new drugs showing great results in international conferences, but they’re still unavailable here. It makes us feel left behind.”

“Patients should have more flexible and broader treatment options,” Paik said. “If a doctor believes a certain drug will work better, patients should be able to access it. I hope we can build an environment where effective treatments are available ‘just in time.’”