Immunotherapy for kidney cancer

Immunotherapy is sometimes used to treat advanced kidney cancer. Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy is sometimes called biological therapy.

You may be offered immunotherapy if:

• you have an allergic reaction to or severe side effects from targeted therapy drugs
• the kidney cancer no longer responds to targeted therapy
• you have intermediate or poor risk metastatic kidney cancer based on the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC)

The following drugs are used in immunotherapy for kidney cancer.

The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints. Kidney cancer cells sometimes block these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors work by blocking the checkpoint proteins so immune system cells (called T cells) attack and kill the cancer cells.

Nivolumab (Opdivo) may be offered if the kidney cancer is no longer responding to a VEGF targeted therapy drug. It may also be combined with another immune checkpoint inhibitor called ipilimumab (Yervoy) to treat advanced kidney cancer. Nivolumab may also be combined with a targeted therapy drug called cabozantinib (Cabometyx) to treat advanced kidney cancer that cannot be treated with surgery or radiation therapy or for kidney cancer that has spread (called metastatic kidney cancer).

Pembrolizumab (Keytruda) is an immune checkpoint inhibitor that may be used treat advanced or metastatic kidney cancer that hasn't been treated with systemic therapy. It is given along with the targeted therapy drug axitinib (Inlyta).

Cytokines are proteins made by certain cells of the immune system. They can also be made in a lab and given as a drug. Cytokines activate the immune system to help shrink kidney cancer cells. Cytokines are not usually used because only a small number of people with kidney cancer will respond to cytokines and there are severe treatment side effects.

High-dose interleukin-2 (aldesleukin, Proleukin) is the most common cytokine used. It can cause serious side effects, so it must only be given at cancer centres that have experience giving this treatment. High-dose interleukin-2 is only given to people who are healthy enough to tolerate the side effects and is rarely used.

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 only a few side effects.

Side effects of immunotherapy will depend mainly on the type of drug or drug combination, the dose and your overall health. Some common side effects of immunotherapy for kidney cancer are:

• flu-like symptoms, such as fever, chills, muscle and joint pain
• fatigue
• skin problems, including rash and itching
• loss of appetite
• nausea and vomiting
• diarrhea
• cough
• low blood pressure

You will be watched closely by your doctor closely to see how your body is reacting to immunotherapy.

Be sure to report side effects to the healthcare team. Side effects can happen any time during, immediately after or a few days or weeks after immunotherapy. Sometimes late side effects develop months or years later. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Your healthcare team is there to help. They will watch you carefully so that serious side effects can be treated right away. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about immunotherapy. To make the decisions that are right for you, ask your healthcare team questions about immunotherapy.