Cancer affects us all in some way, with Europe alone accounting for a quarter of the world’s cancer cases. Among the diverse types of cancer, kidney cancer, often referred to as Renal Cell Carcinoma (RCC), presents a significant health challenge globally.
On World Kidney Cancer Awareness Day 2025, Trinity College Dublin (TCD) reaffirms its commitment to combating this disease through cutting-edge research, aiming to enhance understanding, improve treatment, and support effective health policies. TCD's efforts are deeply integrated with its clinical partners, including the Trinity St. James's Cancer Institute (TSJCI) and various teaching hospitals, to translate scientific discoveries directly into patient benefit.
Key Areas of Research at TCD & Impact on Health Policy & Public Practice
TCD's research into kidney cancer spans several crucial areas, from understanding its prevalence and associated risks to developing advanced diagnostics and therapeutic strategies.
- Understanding Health Harms, Risk Factors, and Patient Burden Linked to Kidney Cancer:
TCD researchers have investigated various factors contributing to the burden of kidney cancer, with a particular focus on vulnerable populations and systemic health impacts.
- Malnutrition in Older Adults with Cancer: Research by Prof Román Romero-Ortuño and colleagues highlights that malnutrition is a significant concern in older adults (≥60 years) with cancer, with a prevalence of 41.9%. Malnutrition stems from disruptions in nutrient balance and inflammatory activity, leading to changes in body composition and functional decline, which can profoundly impact survival. The same study identified urologic cancers, including kidney and bladder cancers, as having an odds ratio (OR: 7.26) for malnutrition in older adults(*). These findings underscore the importance of tailored nutritional assessment and support strategies for older cancer patients.
Trinity College Dublin's Discipline of Medical Gerontology is involved in research on the frequency of malnutrition in older adults with cancer.
* OR of 7.26 means that older adults with urologic cancers (kidney and bladder cancers) were 7.26 times more likely to be malnourished compared to older adults without cancer (the control group) in this study.
- Link to ANCA-associated Vasculitis (AAV): A recent study involving Prof Mark Little and colleagues has revealed a higher malignancy risk, including kidney cancer, in Chinese patients with AAV compared to the general population. Kidney malignancies had a standardised incidence ratio (SIR) of 8.00 in AAV patients without pre-existing malignancies(*). Older age and male gender were identified as significant risk factors for increased malignancy occurrence in AAV patients. Furthermore, a cumulative cyclophosphamide dose(**) exceeding 20.0g was significantly associated with a higher malignancy risk (SIR: 11.54) for urologic cancers (kidney, bladder, renal pelvis) when malignancies developed beyond 5 years after AAV diagnosis. These findings suggest that both AAV itself and the use of cyclophosphamide may contribute to the increased incidence of malignancies. Therefore, understanding this link may help doctors identify at-risk patients and potentially offer new preventive approaches.
* An SIR of 8.00 means that the specific type of cancer being discussed occurred 8 times more frequently in this group of AAV patients than it would in a similar group of people (matched for age, gender, and follow-up time) from the general population.
** Cyclophosphamide is a powerful immunosuppressive drug used to treat AAV. "Cumulative dose" means the total amount of the drug a patient received over time. This finding indicates that receiving more than 20 grams of cyclophosphamide over time was linked to a much higher risk of developing cancer.
- Comprehensive Cancer Research and Ageing & Policy Impact: The Trinity St. James's Cancer Institute is the first Irish cancer institute to be accredited by the Organisation of European Cancer Institutes (OECI), delivering comprehensive cancer services across all age groups, including older adults. Their research themes include Cancer Prevention and Early Diagnosis and Cancer Survivorship and Supportive Care, which are crucial for an ageing population facing a higher risk of cancers like kidney cancer. By integrating world-class research with patient services and treatments, TCD aims to improve the treatment and management of cancer in a way that allows people to live good quality lives. This impact is pivotal given the global population aged 60 and over is projected to more than double by 2050. For instance, The Irish Longitudinal Study on Ageing (TILDA), a world-leading study on ageing in Ireland, provides a solid evidence base that has significantly impacted the understanding of population ageing in Ireland and informed policy and practice in various areas, such as home support services for people aged over 65 years. This policy-informing research can be leveraged to develop tailored health interventions and support systems for older adults at risk of, or living with, kidney cancer. Furthermore, TILDA's designation as a WHO Collaborating Centre for Longitudinal Studies on Ageing and the Life Course highlights its world-renowned reputation and its role in informing global efforts to collect data on older populations.
- Advancing Diagnostics and Treatment Strategies for Kidney Cancer:
TCD and its clinical partners are at the forefront of developing and evaluating innovative approaches for kidney cancer diagnosis and treatment.
- Multiomics and Precision Oncology: TCD researchers have been involved in pioneering what is called “multiomics”. This combines a highly detailed and view of cancer by analysing all its biological information, ranging from its genetic blueprint (genomics), to the messages it sends (transcriptomics), to the functional assemblies it produces (proteomics). This approach is fundamental to precision medicine, allowing for the measurement of specific molecular abnormalities to guide individualised therapeutic strategies. This advanced molecular testing, including DNA sequencing technologies like next-generation sequencing (NGS), whole-exome sequencing (WES), and whole-genome sequencing (WGS), is becoming a standard of care in oncology. Prof David Gallagher, from St. James’s Hospital and Trinity College Dublin, is a co-author on a publication discussing the essentials of multiomics integrating technologies like genomics and proteomics for precision cancer medicine. Critical to the success of multiomics is high-quality tissue collection and preservation, ideally through immediate freezing in liquid nitrogen to prevent molecular degradation. This approach is essential for accurate molecular analyses and advancing oncology.
- Liquid Biopsies: Circulating tumour DNA (ctDNA) from blood samples is emerging as a highly promising circulating biomarker in clinical practice. Liquid biopsies offer real-time information on a patient's cancer, and unlike single-site tumour biopsies, they can better reflect the intra- and inter-tumoral heterogeneity. This technology is invaluable for detecting heterogeneous resistance alterations and can swiftly aid in subsequent therapy selection, as well as for cancer screening and monitoring minimal residual disease. The All-Ireland Cancer Liquid Biopsies Research Consortium (CLuB), led by TSJCI, is a significant initiative dedicated to advancing liquid biopsy research with societal and economic benefits.
- Clinical Trials Infrastructure: TCD, in partnership with St. James's Hospital, operates the Wellcome-HRB Clinical Research Facility (SJH-CRF). This state-of-the-art facility is dedicated to patient-focused research and has conducted over 250 studies and 85 regulated clinical trials. The SJH-CRF has been instrumental in attracting clinical trials to Ireland, enabling Irish patients to access novel treatments without needing to travel overseas.
- Combination Therapies: The combination of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) is a key strategy for solid organ malignancies, including renal cell carcinoma (RCC). RCC is one of the most common disease types studied in clinical trials using these combination therapies. A systematic review involving Prof Grainne O’Kane revealed that while these combinations can work together to improve treatment effectiveness, they often cause severe side effects (about 56% of patients overall, and 58% in RCC). The side effect profile of TKIs varies according to their specific targets. TKIs that inhibit vascular endothelial growth factor (VEGF) or multiple signalling pathways are frequently associated with hypertension, while those designed to target specific oncogenic drivers commonly induce dermatologic reactions such as skin rashes and immune-related adverse events. Understanding these distinct toxicity patterns is crucial in optimising combination therapies involving immune checkpoint inhibitors and TKIs in renal cell carcinoma, as it informs personalised treatment strategies and enhances patient safety.
- Radiotherapy and Immunotherapy: Radiotherapy is a foundational treatment in cancer management, used in approximately 50% of cancer patients. Research led by Dr Noel Donlon and colleagues in radiobiology at the TSJCI, focused on improving outcomes through innovative approaches. For instance, the study suggested that hypofractionated radiotherapy(*) may induce more immunogenic changes(**) in the tumour microenvironment. Ongoing clinical trials are exploring combinations of immunotherapy with radiotherapy, including in renal cell carcinoma (i.e., clinical trial NCT04090710 for ongoing Phase II clinical trial), aiming to enhance anti-tumour immunity and overcome treatment resistance. Trinity St. James's Cancer Institute has established a Cancer Clinical Trials Unit (CCTU), where it is actively involved in clinical trials.
* Method of radiation therapy where higher doses of radiation are delivered per treatment session over a fewer number of total sessions or fractions.
** Alterations within the tumour and its microenvironment that make it more visible and susceptible to attack by the body's immune system.
TCD's diverse research in kidney cancer, from understanding its intrinsic links to other conditions like AAV and malnutrition in older adults, to pioneering multiomic diagnostics and combination therapies, provides robust evidence to advance patient care and inform national health policies. This commitment to world-class research, coupled with strong clinical partnerships, positions TCD as a leader in the global fight against kidney cancer.