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Kidney cancer


Treatment for advanced kidney cancer


When kidney cancer has spread to lymph nodes or other parts of the body (stage 3 or 4), it’s known as advanced or metastatic cancer. The aim of treatment is to slow the spread of the cancer and to manage any symptoms.

A combination of different treatments may be recommended, depending on several factors, including how soon after diagnosis you start systemic treatment, blood counts, blood calcium levels and your general health.

Systemic treatment

Drugs that reach cancer cells throughout the body are called systemic treatments. Targeted therapy and immunotherapy are the main systemic treatments used to control advanced kidney cancer.

The types of drugs and combinations used are rapidly changing as clinical trials show better responses and improved survival with newer drugs. Since the development of these more effective systemic treatments, chemotherapy is rarely used for kidney cancer.

Talk with your doctor about whether you are a suitable candidate. Ask them about the side effects you might have, as most can be managed and treating them early is likely to reduce how long they last.

The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of targeted therapy or immunotherapy drugs as long as certain criteria are met. Medicines or treatments that are not on the PBS are usually very expensive unless given as part of a clinical trial. 

Learn more about clinical trials

Active surveillance

In some cases, kidney cancer grows so slowly that it won’t cause any problems for a long time. Because of this, especially if the advanced kidney cancer has been found unexpectedly, your doctor may suggest looking at the cancer regularly, usually with CT scans. This approach is known as active surveillance or observation. If the cancer starts to grow quickly or cause symptoms, active treatment will be recommended.

Targeted therapy

This is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading. Targeted therapy drugs are usually used as the first treatment for advanced kidney cancer (first-line treatment).

Kidney cancer often stops responding to particular targeted therapy drugs. If this happens, your doctor will usually suggest another drug or immunotherapy combination. Research shows that having targeted therapy drugs together with immunotherapy has led to better response rates in certain people. 

Types of targeted therapy drugs

These drugs can get inside cancer cells and block certain enzymes and proteins that tell cancer cells to grow, multiply and spread. The main groups of targeted therapy drugs for advanced kidney cancer are:

Tyrosine kinase inhibitors (TKIs)
  • These drugs block a group of enzymes called tyrosine kinases from sending signals that tell cancer cells to grow. Without this signal, the cancer cells die.
  • Approved for use for some types of advanced kidney cancer.
  • Taken as a daily tablet. Often given in repeating cycles, with rest periods in-between. Some may be taken for many months or even years.
  • Side effects may include fatigue, mouth ulcers, changes in appetite, fevers, allergic reactions, skin rashes, diarrhoea, blood-clotting issues and blood pressure changes.
mTOR inhibitors
  • These drugs block the mammalian target of rapamycin (mTOR), an enzyme that tells cancer cells to grow and spread.
  • Approved for use for some types of advanced kidney cancer that have not responded to TKIs.
  • Taken as a daily tablet. May be taken for many months or even years, and may be given alone or with a TKI.
  • Side effects include diarrhoea, fatigue, skin rash, mouth sores and high blood sugar.

 

Immunotherapy

There have been many advances in treating advanced kidney cancer with immunotherapy drugs known as checkpoint inhibitors. These use the body’s own immune system to fight cancer.

The side effects of immunotherapy can vary – not everyone will experience the same effects. Immunotherapy can cause inflammation in any of the organs of the body, leading to side effects such as fatigue, skin rash and diarrhoea.

Types of immunotherapy drugs

Checkpoint inhibitors approved to treat advanced kidney cancer include ipilimumab and nivolumab. The drugs are usually given into a vein. Taking these drugs together has been shown to work well as a first-line treatment for advanced kidney cancer. In people with advanced kidney cancer previously treated with a tyrosine kinase inhibitor, nivolumab has been shown to work well as a second-line treatment.

Clinical trials are testing checkpoint immunotherapy at many stages of kidney cancer – after surgery (adjuvant treatment), as the first treatment for advanced kidney cancer, and together with existing kidney cancer drugs, such as in combination with TKIs. Clinical trials are also testing new types of immunotherapy and targeted therapy drugs.

 

Radiation therapy

Radiation therapy uses a controlled dose of radiation, such as focused x-ray beams, to kill or damage cancer cells. It may be used in advanced kidney cancer to shrink a tumour and relieve symptoms such as pain and bleeding (palliative treatment).

The treatment is painless and usually lasts for a total of 10–20 minutes. The number of treatment sessions you have depends on your situation. You might have some temporary side effects, such as fatigue, nausea, loss of appetite, diarrhoea and skin irritation, which can be managed.  

Surgery

Surgery to remove kidney cancer that has spread is known as cytoreductive surgery. This can involve removing the primary cancer in the kidney by nephrectomy, or removing some or all of the tumours that have spread (metastasectomy).

Recent studies suggest that treatment with targeted therapy is as effective as targeted therapy combined with cytoreductive surgery.

Cytoreductive nephrectomy may be offered when the kidney cancer is causing symptoms, or when there is very little cancer spread outside the kidney. It can also be used in some people who have responded well to systemic treatment. Generally, surgery is not recommended if you are unwell or if the cancer has spread to many places in the body.

Palliative treatment

In some cases of advanced kidney cancer, the medical team may talk to you about palliative treatment, which helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease.

Many people think that palliative treatment is for people at the end of their life, but it may be beneficial for people at any stage of advanced kidney cancer. It is about living for as long as possible in the most satisfying way you can.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs.

Learn more

Follow-up appointments

After treatment for early kidney cancer, you will need regular check-ups to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread. During these check-ups, you will usually have a physical examination and you may have ultrasounds, CT scans or blood tests.

If you have advanced kidney cancer, you will have appointments with your treatment team on an ongoing basis. Check-ups will become less frequent if you have no further problems. Between follow-up appointments, let your doctor know immediately of any symptoms or health problems.

For some people, kidney cancer does come back after treatment, which is known as a recurrence. It is important to have regular check-ups, so that if cancer does come back, it can be found early. If the cancer recurs in the kidney (after a partial nephrectomy), you may be offered more surgery. If the cancer has spread beyond the kidney, your doctor may suggest targeted therapy, immunotherapy or radiation therapy, or occasionally surgery.

Question checklist

Asking your doctor questions will help you make an informed choice about your treatment and care. You may want to include some of the questions below in your own list:

  • What type of kidney cancer do I have?
  • Has the cancer spread? If so, where has it spread? How fast is it growing?
  • Are the latest tests and treatments for this cancer available in this hospital? Are there clinical guidelines for this type of cancer?
  • Will a multidisciplinary team be involved in my care?
  • What treatment do you recommend? What is the aim of the treatment?
  • Are there other treatment choices for me? If not, why not?
  • If I don’t have the treatment, what should I expect? How long do I have to make a decision?
  • I’m thinking of getting a second opinion. Can you recommend anyone?
  • How long will treatment take? Will I have to stay in hospital?
  • Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
  • How will we know if the treatment is working?
  • Are there any clinical trials or research studies I could join? 
  • What are the risks and possible side effects of each treatment?
  • Will I have a lot of pain? What will be done about this?
  • Can I work, drive and do my normal activities while having treatment?
  • Will the treatment affect my sex life and fertility?
  • Should I change my diet or physical activity during or after treatment?
  • Are there any complementary therapies that might help me?
  • How often will I need check-ups after treatment? Who should I go to for my check-up appointments?
  • If the cancer returns, how will I know? What treatments could I have?

 

Understanding Kidney Cancer

Download our Understanding Kidney Cancer booklet to learn more

Download now

 

Expert content reviewers:

A/Prof Daniel Moon, Urologic Surgeon, Australian Urology Associates, and Honorary Clinical Associate Professor, The University of Melbourne, VIC; Polly Baldwin, 13 11 20 Consultant, Cancer Council SA; Ian Basey, Consumer; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Tina Forshaw, Advanced Practice Nurse Urology, Canberra Health Services, ACT; Dr Suki Gill, Radiation Oncologist, Sir Charles Gairdner Hospital, WA; Karen Walsh, Nurse Practitioner, Urology Services, St Vincents Private Hospital Northside, QLD; Dr Alison Zhang, Medical Oncologist, Chris O’Brien Lifehouse and Macquarie University Hospital, NSW.

Page last updated:

The information on this webpage was adapted from Understanding Kidney Cancer - A guide for people with cancer, their families and friends (2020 edition). This webpage was last updated in September 2021. 

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