Treatment for advanced kidney cancer

Saturday 1 November, 2014

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On this page: Surgery | Targeted therapies | Immunotherapy | Radiotherapy | Palliative treatment | Key points


When kidney cancer has spread outside the kidney and to other parts of the body, the main treatment is targeted therapy. Surgery to remove the kidney with cancer might also be recommended to help control the cancer. Other treatments might include immunotherapy and radiotherapy.

Surgery

Surgery to remove the kidney when the cancer has spread is called cytoreductive nephrectomy. There is sometimes a chance that surgery will improve survival from the cancer, and it can also reduce current symptoms or the risk of future symptoms from the cancer in the kidney.

Generally, surgery is not recommended if the cancer has spread to several places in the body.

Targeted therapies

Some newer types of treatment, called targeted therapies, attack specific cancer cells or blood vessels to stop or slow down growth or reduce the size of the tumour. They are different from standard chemotherapy drugs that act against all actively dividing cells, including normal cells (such as hair or nails cells) and cancer cells.

Two classes of targeted drugs, called tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin (mTOR) inhibitors, have recently been trialled in people with advanced kidney cancer. Both drugs block the signals that tell cancer cells to grow and divide.

Treatment – usually given in tablet form – has been shown to make both primary and secondary cancers shrink or stop growing.

For renal cell carcinoma that has spread beyond the kidney, TKIs (and sometimes mTOR inhibitors) are the most common treatment offered. The targeted therapy drug you are given might stop working after some time. In this case, your doctor might prescribe another drug. It is common to change drugs as they stop working. Common targeted therapies include:

  • Sunitinib (Sutent ®) – One of the first targeted therapies usually prescribed. Available on the Pharmaceutical Benefits Scheme (PBS) as long as certain criteria are met.
  • Pazopanib (Votrient ®) – One of the first targeted therapies usually prescribed. Available on the PBS as long as certain criteria are met.
  • Sorafenib (Nexavar ®) – Approved for use in Australia, but is not yet reimbursed on the PBS.
  • Everolimus (Afinitor ®) – Used as a second treatment if another targeted therapy has stopped working. This is not available on the PBS in this situation.
  • Axitinib (Inlyta ®) – Used if other targeted therapies stop working.
  • Temsirolimus (Torisel ®) – Used only in certain situations. This is given as an injection into a vein (intravenously). 

These treatments have side effects; your treating doctor will discuss these and provide information for you to take home.

Clinical trials of newer targeted therapies might also be available – ask your medical oncologist if you are eligible. 

Immunotherapy

Immunotherapy (also called biological therapy) is sometimes used to treat advanced kidney cancer. The aim of immunotherapy is to boost the body’s immune system to help it fight off disease and shrink the tumour. The drugs that are used have been developed from cytokines, which are proteins that naturally occur in the body and stimulate the immune system.

This treatment is still a topic of research and clinical trials. It is most often used in countries that do not have access to targeted therapies.

Immunotherapy often works better if the kidney with the tumour is removed, so your surgeon might first perform an operation. Treatment is given intravenously or orally. You might also be given bevacizumab (Avastin®), which is given intravenously and is classified as a targeted therapy. Avastin works by slowing the growth of new blood vessels in the cancer.

Although the drugs are made from natural substances, they can sometimes cause side effects. Tell your doctor or nurse if you experience fever, chills, muscle aches, fatigue and soreness at the injection site.

Chemotherapy isn’t usually used for treating kidney cancer – other treatments such as targeted therapies or immunotherapies seem to work better. New drugs are being tested in clinical trials or in combination with targeted therapy or immunotherapy. 

Radiotherapy

Radiotherapy uses high-energy radiation to kill or damage cancer cells. This treatment is not effective in treating primary kidney cancer. However, radiotherapy might be used as palliative treatment (see below).

If you have radiotherapy, the total number of treatments and their duration depends on your situation. You might have some side effects, such as fatigue, nausea, appetite loss, diarrhoea, tiredness and skin irritation. Talk to your doctor and nurses about any side effects so you can get advice about managing them.

Fore more information see the radiotherapy or overcoming cancer pain sections or call Cancer Council 13 11 20. We can also provide a free relaxation CD or meditation CD, which might help reduce your pain and anxiety.  

Palliative treatment

Palliative treatment helps to improve quality of life by alleviating symptoms of cancer without trying to cure the disease. Palliative care is particularly important for people with advanced cancer. However, it is not just for people who need end-of-life care; it can be used at all stages of cancer when required. Often treatment is concerned with pain relief and controlling the spread of cancer, but it can also involve the management of other physical and emotional symptoms, such as bleeding, bowel problems, mobility issues, or stress and anxiety.

Treatment might also include radiotherapy, arterial embolisation, chemotherapy or other types of medication.

For more information see the palliative treatment or advanced cancer sections or call Cancer Council 13 11 20. 

Key points

  • Advanced cancer means the cancer has spread from where it started to another part of the body, or it has come back some time after you were first treated.
  • Surgery is sometimes used to remove the kidney (cytoreductive nephrectomy) if the tumour has spread to only one other area.
  • Targeted therapies work by interfering with signals that tell cancer cells to grow.
  • Two classes of targeted drugs, called tyrosine kinase inhibitors (TKIs) and mTOR inhibitors, are most commonly used. The targeted therapy drug you are given might stop working after a while, and you will then be prescribed a different drug.
  • Immunotherapies, also called biological therapies, encourage the immune system to fight cancer cells. Treatment is given intravenously or orally.
  • Radiotherapy might be used to shrink advanced kidney cancer and reduce symptoms.
  • People with more advanced cancer might be offered palliative treatment, such as radiotherapy and arterial embolisation. Palliative treatment is given to ease the symptoms of the cancer, rather than to cure the disease.
  • All of the treatments can cause side effects, such as pain or fatigue. The side effects you experience will depend on your situation. You will also need time to recover from different treatments. Talk to your doctor about how to manage any side effects and your recovery. 

Reviewed by: A/Prof Manish Patel, Urological Cancer Surgeon, University of Sydney and Westmead and Macquarie University Hospitals, NSW; Prof Ian Davis, Professor of Medicine and Head of Eastern Health Clinical School, Faculty of Medicine and Nursing and Health Science, Monash University, and Senior Medical Oncologist, Eastern Health, VIC; Karen Hall, Nurse Counsellor, Helpline, Cancer Council SA, and Clinical Nurse, Oncology/Haematology Inpatient Unit, Flinders Medical Centre, SA; Julie McGirr, Cancer Helpline Nurse, Cancer Council Victoria, VIC; and Jodie Turpin, Consumer.

Updated: 01 Nov, 2014