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Targeted therapy for kidney cancer
Most people with advanced kidney cancer that has spread, or metastasized, will have targeted therapy. It uses drugs to target specific molecules (such as proteins) on or inside cancer cells. These molecules help send signals that tell cancer cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Targeted therapy may also be called molecular targeted therapy.
Targeted therapies are used mainly for clear cell, or conventional, renal cell carcinoma (RCC), which is the most common type of kidney cancer. You may have targeted therapy to:
- kill or control kidney cancer cells
- relieve pain or control the symptoms of advanced kidney cancer (called palliative therapy)
Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of targeted therapy. You may also receive other treatments.
Deciding which targeted therapy to use
Your healthcare team will consider certain prognostic and predictive factors to help them decide which targeted therapy would be the most effective for you. One important factor is any treatment you have already been given for kidney cancer.
Targeted therapies used to treat kidney cancer block certain protein pathways in the body:
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.
Mammalian target of rapamycin (mTOR) is a protein that helps control cell growth, reproduction and survival.
PD-1 is a protein that helps control cell death.
Surgery and targeted therapy
Before starting targeted therapy, you may have surgery to remove the kidney with the tumour and as much of the cancer outside the kidney as possible. This surgery is called cytoreductive nephrectomy. It is thought that removing as much cancer as possible will make targeted therapy more effective. You may also be offered surgery after you start targeted therapy if tests show that the cancer is responding to the treatment.
Targeted therapy drugs commonly used for kidney cancer
Targeted therapy is given until the kidney cancer no longer responds to treatment.
The most common targeted therapy drugs that work on VEGF to treat kidney cancer are:
- sunitinib (Sutent) – usually the first drug to be used as it has been shown to be the most effective
- pazopanib (Votrient)
- sorafenib (Nexavar)
- axitinib (Inlyta)
The most common targeted therapy drugs that work on mTOR to treat kidney cancer are:
- temsirolimus (Torisel) – used for kidney cancers that aren’t a clear cell type or for kidney cancer with poor prognostic factors
- everolimus (Afinitor)
The targeted therapy drug that works on PD-1 is nivolumab (Opdivo). This drug, called a PD-1 checkpoint inhibitor, is only given if kidney cancer is no longer responding to a VEGF or mTOR drug.
Most targeted therapies for kidney cancer are given as pills or tablets. Temsirolimus is given as an intravenous (IV)intravenous (IV)Within or into a vein (a blood vessel that carries blood from tissues and organs in the body to the heart). injection.
If kidney cancer does not respond to drugs used in earlier treatments or if it comes back (recurs), you may be offered one of the targeted therapies that you have not had yet.
If your cancer stops responding to a second targeted therapy, you may be offered a third targeted therapy drug that you haven’t been given yet. There are no standard treatments for kidney cancer that has stopped responding to 2 or more targeted therapy drugs.
Side effects can happen with any type of treatment for kidney cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Targeted therapy doesn’t usually damage healthy cells, so it tends to cause fewer and less severe side effects than chemotherapy and radiation therapy. Chemotherapy and radiation therapy can damage healthy cells along with cancer cells.
If side effects develop with targeted therapy, they can happen any time during, immediately after or a few days or weeks after targeted therapy. Sometimes late side effects develop months or years after targeted therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of targeted therapy will depend mainly on the type of drug or combination of drugs, the dose, and your overall health. Some common side effects of targeted therapy for kidney cancer are:
- skin problems
- bone marrow suppression
- nausea and vomiting
- digestive problems (heartburn, gas, bloating)
- weight loss
- muscle and joint pain
- liver damage
- hair loss
Tell your healthcare team if you have these side effects or others you think might be from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them. If you have a lot of trouble with side effects, your healthcare team may change the dose or type of targeted therapy drug.
Information about specific targeted therapy drugs
Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about targeted therapy
Facing the financial burden of cancer
The Canadian Cancer Society provides helpful information about government income programs, financial resources and other resources available to families struggling to make sense of the personal financial burden they face.