Targeted therapy for kidney cancer

Most people with advanced kidney cancer that has spread will have targeted therapy. It 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. Targeted therapy may also be called molecular targeted therapy.

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.

Your healthcare team will consider your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognostic and predictive factors help doctors decide which targeted therapy would be the most effective for you. One important factor is any treatment you already had 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 that allows tumours to grow larger.

Mammalian target of rapamycin (mTOR) is a protein that helps cells grow and divide.

Tyrosine kinase is a protein on the surface of cells that sends signals to help cells grow and form new blood vessels.

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 a cytoreductive nephrectomy. 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 treatment is working.

The most common targeted therapy drugs that work on VEGF to treat kidney cancer are:

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

The most common targeted therapy drugs that work on mTOR to treat kidney cancer are:

• temsirolimus (Torisel)
• everolimus (Afinitor)

A targeted therapy drug that works on tyrosine kinase (called a tyrosine kinase inhibitor) to treat advanced 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.

Most targeted therapies for kidney cancer are given as pills or tablets. Temsirolimus is given directly into a vein (intravenously).

If kidney cancer does not respond to drugs used in earlier treatments or if it comes back, you may be offered different targeted therapies.

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.

Targeted therapy attacks cancer cells but doesn’t usually damage healthy cells, so there are usually fewer and less severe side effects than with chemotherapy or radiation therapy. Chemotherapy and radiation therapy can damage healthy cells along with cancer cells.

If you develop side effects, 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, including hand-foot syndrome and rash
• diarrhea
• fatigue
• high blood pressure (hypertension)
• sore mouth
• nausea and vomiting
• constipation
• weight loss
• muscle and joint pain
• liver damage

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.

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 targeted therapy. To make the decisions that are right for you, ask your healthcare team questions about targeted therapy.