Peggy Zuckerman is a Resilient Kidney Cancer Survivor and Here’s Why She is a Passionate Advocate for Awareness

In 2004, North Dakota resident and educator Peggy Zuckerman was told by her doctor that she had a tiny, scabbed-over stomach ulcer. She had previously indicated a family history of alcoholism, and her doctor determined that she must be an alcoholic – this would explain her changing liver measures. Ultimately, Peggy went in for an ultrasound so her doctor could do the biopsy to determine if she had cirrhosis, a scarring of the liver. While performing the ultrasound, suddenly the technician turned the screen away from Peggy. She would soon learn that she had Stage IV kidney cancer.

“Silence descended, and I could not get answers to any questions,” Peggy recalls. “Within a few hours, I was getting a CAT scan, (and) I could see the (medical team) behind the glass wall, obviously quite concerned about what they were seeing.”

Want to do something impactful for kidney cancer immunotherapy research? Your contribution can help fuel the future of cancer treatment and care by making a donation today to the Cancer Research Institute.

After making some calls to the Mayo Clinic in Rochester, Minnesota, Peggy saw an oncologist there the following week. She would learn that not only did she have Stage IV kidney cancer, but the tumor was nearly four inches (10 centimeters) in size and had metastasized to her lungs. Thankfully, Peggy had a nephrectomy (surgical removal of a kidney) and was on her way back home within a week.

“(I) had a recommendation to seek out a UCLA doctor with whom I could discuss (receiving a) high dose of interleukin either there (or) perhaps back in Minnesota,” Peggy says, referencing her specific immunotherapy treatment. “That was the first time I think I ever heard the (term) ‘immunotherapy,’ per se.”

The cancer immunotherapy research landscape is fluid and constantly adapting to new discoveries and avenues of investigation. Kidney cancer is the eighth most common cancer in the U.S., measuring approximately 82,000 new cases and causing 15,000 deaths in 2023. Globally, it is responsible for about 400,000 cancer diagnoses and 175,000 deaths.

Approximately 9 in 10 kidney cancer diagnoses are renal cell carcinoma, which form in the lining of the kidney’s tubules. Risk factors for inducing kidney cancer are tobacco consumption, obesity, high blood pressure, exposure to certain industrial chemicals, and other factors. The most at-risk population for kidney cancer is people 55 and older.

Early screening is extremely important for kidney cancer since there are usually no symptoms in the early stages. Per the Moffitt Cancer Center, there are four ways to screen for kidney cancer:

1. Intravenous pyelogram (IVP) – a contrast dye is injected into the patient’s bloodstream, followed by X-rays that follow the dye as it travels through the patient’s kidneys, ureters, and bladder.

2. CT scan – a series of detailed X-rays are produced from different angles. Sometimes a dye is used in the bloodstream to highlight the kidneys in the images.

3. Magnetic resonance imaging (MRI) – radio waves and a magnet help produce detailed images of the kidneys and nearby tissues.

4. Ultrasound – high-energy sound waves reflect off of internal tissues, creating echoes that form a sonogram, a visual image.

Symptoms for kidney cancer may include lower back pain, blood in the patient’s urine, fatigue, weight loss, and swelling in the lower legs and ankles. Fortunately, there are seven FDA-approved immunotherapy treatments for kidney cancer, including one targeted antibody and six immunomodulators.

Peggy was treated at the University of California, Los Angeles. She was treated with a cytokine called interleukin. Cytokines are chemicals that stimulate the immune system, but today they are only implemented against cancers that are unresponsive to targeted therapies because of an added risk of serious side effects.

“I do not remember much of the (first) week at all,” Peggy says. “It was mostly reported to me by my family and friends. I was obviously quite sick, which is what interleukin will do (to you), (and) you have a reaction as if you have a very tough flu.”

Not everyone reacts the same way to immunotherapy treatments. It is always important to consult your doctor to determine if immunotherapy, and then what treatment, might be right for you or a loved one.

Immunologists care deeply about creating immunotherapy treatments with reduced side effects so that fewer patients feel flu-like symptoms like Peggy experienced. CRI scientists are dedicated to making progress with kidney cancer immunotherapy research. Haydn Kissick, PhD, assistant professor, Emory Vaccine Center, Department of Urology/Department of Microbiology and Immunology, and CRI Lloyd J. Old STAR, works in a lab with aims to understand the basic mechanisms behind immune responses to kidney tumors. He says that when patients have a robust immune response to their tumor at the time of surgery, the rate of metastasis drops.

“Kidney cancer is one of the cancers that has been most responsive to checkpoint immunotherapy, and we have used (interleukin) to treat this cancer since 1992. It is one of the few cancers that is on the rise,” Dr. Kissick explains. “It is a highly treatable disease if caught early by surgery and immunotherapy, and new drugs like Cabozantinib might not directly target the immune system but rely on it for (its) main effect. I believe in our lifetime this will be a disease that will be almost entirely treated with drugs that use a patient’s immune system to defeat it.”

Peggy is passionate about informing the public about the benefits of immunotherapy pertaining to kidney cancer treatment. About six weeks after her surgery, she was at a kidney cancer patient seminar, and that is where she realized she could have a role in relaying important information about cancer immunotherapy to the public.

“When the oncologist left and the meeting was over, somebody turned around to the larger group and said, ‘Did anybody understand any of this,’” Peggy says. “I am a schoolteacher and I figured I could help translate what we had just heard given a bit of time and (a) dictionary. Somebody else said, well, let us get together and keep talking about this and create our own support group.”

Peggy wants to empower patients to help themselves and each other. She says if your doctor cannot explain your cancer and treatment options to your satisfaction, then you might want to look for another opinion.

“When you hear you have cancer, your brain goes to mush. Then you are then asked to be part of the decision-making team (with your treatment),” Peggy emphasizes. “Another patient who has had a similar experience and (is) able to articulate what it means to try to manage immune side effects or how long it takes to recover from surgery, that can be invaluable to (another) patient.”

An important thing to understand about kidney cancer is that treatment will vary from patient to patient. There is no ‘one size fits all’ approach to treating it with immunotherapy, and CRI scientists can attest to that fact.

Sangeeta Goswami, MD, PhD, is assistant professor, Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center; assistant professor, Department of Immunology, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center; former CRI CLIP Investigator, and CRI clinical innovator review committee member who spoke at CRI’s 2022 Virtual Immunotherapy Patient Summit. Dr. Goswami discussed the rapid acceleration in kidney cancer treatment over the past few years.

“The recent developments have been very encouraging in the field of kidney cancer,” Dr. Goswami states. “The FDA has approved Belzutifan for people with Von Hippel-Lindau disease who have clear-cell kidney cancer. This is the first drug approved to treat cancers associated with this hereditary condition.”

However, Dr. Goswami also says that there are areas where she wants to see immunotherapy address unmet needs regarding some of the nuances of kidney cancer treatment.

“While immune checkpoint therapy is approved for clear cell kidney cancer, the response rates have been low in other subtypes such as papillary and chromophobe RCC,” Dr. Goswami says. “We will need more translational and discovery science research to investigate the pathways of resistance in these subtypes to develop combination therapy.”

Steadfast cancer awareness advocates like Peggy play an instrumental role in patient education for kidney cancer. Drs. Kissick and Goswami are fighting kidney cancer from a lab setting and conducting crucial scientific research to improve patients’ lives. We are confident that their efforts can help us all create a world immune to cancer.

Want to do something big for kidney cancer immunotherapy research? Make a donation today to the Cancer Research Institute.