Kidney cancer

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Treatments for stage 4 kidney cancer

The following are treatment options for stage 4 kidney cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Targeted therapy

Targeted therapy is the standard treatment for stage 4 kidney cancer. Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells.

Your healthcare team will consider a number of risk factors, or predictors of survival, to help them decide which targeted therapy would be the most effective for you. These risk factors include the type of kidney cancer as well as any other treatments you’ve already received.

Vascular endothelial growth factor (VEGF) is one of the main proteins that help to build a blood supply, which a small tumour needs to grow larger. Targeted therapy drugs that work on VEGF to treat stage 4 kidney cancer include:

  • sunitinib (Sutent) – usually the first drug to be used as it has been shown to be the most effective
  • pazopanib (Votrient)
  • sorafenib (Nexavar)

Mammalian target of rapamycin (mTOR) is a protein that helps control cell growth, reproduction and survival. Targeted therapy drugs that work on mTOR to treat stage 4 kidney cancer include:

  • temsirolimus (Torisel) – used for kidney cancers that aren’t a clear cell type or for kidney cancer with poor prognostic factors
  • everolimus (Afinitor)

Tyrosine kinase is a protein on the surface of cells that sends signals to help cells grow and form new blood vessels. A targeted therapy drug that works on tyrosine kinase (tyrosine kinase inhibitor) to treat stage 4 kidney cancer is lenvatinib (Lenvima). It may be used in combination with everolimus if you have been given VEGF targeted therapy before.


You may be offered surgery before you start targeted therapy. The surgeon will remove the kidney with the tumour and as much of the cancer as possible. This surgery is called cytoreductive nephrectomy. It may improve how well you respond to targeted therapy.

You may be offered surgery to treat cancer that has spread only to the brain or lungs. Find out more about treatments for brain metastasis or lung metastasis.


Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells. It may be offered to a few people with stage 4 clear cell, or conventional, renal cell carcinoma (RCC). It is rarely used in Canada because targeted therapies are better at treating kidney cancer.

Immunotherapy may be used in specialized centres to treat people who have kidney cancer that no longer responds to targeted therapy. Your healthcare team will decide if immunotherapy is a good treatment option for you.

Cytokines are the type of immunotherapy used for stage 4 kidney cancer. Cytokines are proteins made and released by immune system cells. The 2 cytokine drugs that may be used are:

  • high-dose intravenous interleukin-2 (Aldesleukin, Proleukin)
  • interferon alfa (Intron A, Wellferon) given as an injection under the skin (subcutaneous injection)

High-dose intravenous interleukin-2 can have serious side effects. It must be given in centres that have experience giving this treatment.

Arterial embolization

A kidney tumour needs blood to grow. Arterial embolization is a procedure that blocks the blood supply to a kidney tumour. It can help shrink the tumour, control bleeding in the kidney and relieve symptoms such as pain. You may be offered arterial embolization if you aren’t well enough to have targeted therapy or surgery.

Ablation therapy

Ablation therapies use heat or cold to destroy the kidney tumour. You may be offered ablation therapy if you can’t have targeted therapy and you aren’t well enough to have surgery.

Radiation therapy

If you aren’t well enough to have targeted therapy, you may be offered external beam radiation therapy. This treatment can help relieve pain, bleeding and other symptoms.

Clinical trials

You may be asked if you want to join a clinical trial for kidney cancer. Find out more about clinical trials.


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