Treatments for recurrent kidney cancer

Recurrent kidney cancer means that the cancer has come back after it has been treated. The following are treatment options for recurrent kidney cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. The treatments you are offered will depend on where the cancer has come back and the treatments you have already received.

Targeted therapy is the main treatment for recurrent kidney cancer. Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells.

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 recurrent kidney cancer include:

• sorafenib (Nexavar)
• pazopanib (Votrient)
• axitinib (Inlyta)
• sunitinib (Sutent)
• cabozantinib (Cabometyx) (may not be covered by all provincial health plans)

Mammalian target of rapamycin (mTOR) is a protein that helps cells grow and divide. Targeted therapy drugs that work on mTOR to treat recurrent kidney cancer include:

• temsirolimus (Torisel)
• 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 (called a tyrosine kinase inhibitor) to treat advanced, recurrent kidney cancer is lenvatinib (Lenvima). It may be used in combination with everolimus if you have been given VEGF targeted therapy before. Lenvatinib may not be covered by all provincial health plans.

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 a cytoreductive nephrectomy. It may improve how well you respond to targeted therapy.

If kidney cancer spreads to the brain or lungs, surgery is sometimes used to treat it. Find out more about brain metastases or lung metastases.

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

If kidney cancer spreads to the bones, radiation therapy is sometimes used to treat it. Find out more about bone metastasis.

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

Immunotherapy helps to strengthen or restore the immune system’s ability to find and destroy cancer cells. Immunotherapy may be used in specialized centres to treat people who have kidney cancer that no longer responds to targeted therapy. Your healthcare team may recommend immunotherapy as a good treatment option for you. Immunotherapy drugs used to treat recurrent kidney cancer includes:

• Nivolumab (Opdivo) may be offered if the kidney cancer is no longer responding to a VEGF targeted therapy drug.
• A combination of nivolumab and ipilimumab (Yervoy) may also be offered for people who have IMDC intermediate and poor risk classification.
• High-dose intravenous interleukin-2 (aldesleukin, Proleukin) is the most common cytokine drug 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.

Chemotherapy is not usually used for kidney cancer. Chemotherapy is used to relieve pain or control the symptoms of advanced kidney cancer (called palliative chemotherapy). Unfortunately, response rates to chemotherapy are usually poor. Because chemotherapy is not usually used to treat kidney cancer, there are no standard drugs or drug combinations.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with kidney cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.