In cases where the kidney cancer is advanced or has spread and surgery alone is not sufficient to control the disease, there are a number of treatment options available.
These drugs have all been specifically designed to target biological changes that occur in kidney tumours, and stop tumours from being able to grow. There are three types of targeted therapy, tyrosine kinase inhibitors, mTOR inhibitors, and monoclonal antibody therapy.
The Tyrosine Kinase Inhibitors (TKIs) inhibit the tyrosine kinase signalling pathway, thus blocking cell growth and division. TKIs used to treat kidney cancer are Sorafenib, Sunitinib, Cabozantinib, Pazopanib, Tivozanib, Lenvatinib (usually given with Everolimus) and Axitinib.
Bevacizumab is a monoclonal antibody used to treat advanced kidney cancer. It works by sticking to a protein called VEGF, which stops it working. This prevents the tumour being able to grow blood vessels, essentially cutting off its food supply.
Immunotherapies boost the immune system’s ability to recognise and kill cancer cells. There are a number of immunotherapies approved to treat advanced kidney cancer, although their availability will depend on where you live. In the UK, some drugs are available on the NHS, some may be accessible through the cancer drugs fund, and some are not available despite being approved for use in other countries. A number of these therapies are known as PD-1 inhibitors. Examples of these available in the UK include Nivolumab and Avelumab (used when the kidney cancer has spread). In the US, Pembrolizumab, combined with axitinib, is also approved for the treatment of advanced kidney cancer. Ipilimumab is another immunotherapy that blocks the CTLA-4 pathway. It is sometimes used in combination with Nivolumab. Other immunotherapies currently used to treat advanced kidney cancer are interferon and Interleukin-2 therapy.
A table of current immunotherapy trials in RCC is available here.
Chemotherapy is not normally used to treat kidney cancer as targeted therapies are more effective. However, chemotherapy might be an effective treatment for any secondary tumours that have been caused by the original kidney tumour spreading to other parts of the body. Additionally, several clinical trials are testing if combining chemotherapy with targeted therapies is more effective than targeted therapy alone.
Like chemotherapy, radiotherapy is not normally used to treat kidney cancer. Kidney cancer is less sensitive to radiotherapy and therefore it is not as effective as other treatments. However, radiotherapy is often used to treat kidney cancer that has spread to the brain and can be used to relieve some of the symptoms of advanced cancer such as pain.
A number of new treatments for kidney cancer are currently being tested and are only available as part of a clinical trial. These include:
- New immunotherapies e.g. Durvalumab, Tremelimumab
- New targeted therapies e.g. Savolitinib
- Vascular targeted phototherapy (VTP) is being researched to treat small renal cell kidney cancers.
In addition, combinations of different types of therapies are being tested to determine whether there is an additive effect of using more than one type of drug. Immunotherapy before or after surgery is also being investigated to prevent the recurrence of tumours.
Publication date: December 2014
Review date: May 2021