Therapies for Advanced Kidney Cancer
Learn About Therapies
Sometimes surgical treatment alone is not sufficient for kidney cancer. If you had metastatic disease (cancer that has spread to other organs) when you were diagnosed, or if you have developed metastatic cancer since your nephrectomy, your doctor will most likely recommend additional treatment. The most commonly used treatments for kidney cancer are various forms of “targeted therapies” or immunotherapy. Targeted therapies — so-called because they “target” cancer at the cellular level — have expanded the options for the treatment of kidney cancer. Other traditional, but less-often used, treatments include radiation therapy and chemotherapy. Several investigational therapies, including vaccine therapy, are also available.
If you are a patient experiencing side effects from any of the FDA-approved medications that follow, the Kidney Cancer Association’s Nurse Telephone Information Service may be able to answer questions and provide assistance: +1 503-215-7921.
National Cancer Institute List of Drugs Approved for Kidney (Renal Cell) Cancer
Click here to open a new window to view information about these drugs.
Though it is not considered a primary form of therapy, radiation can be used in the treatment of kidney cancer that has metastasized to the bone, brain or spine. It may be used to control symptoms – relief from pain, for example.
There are several different types of radiation therapy; all work on the same basic principle of using high-energy radiation to kill cancer cells or slow their rate of growth. Radiation therapy is a “localized” treatment, targeted as precisely as possible at a specific area or tumor. Radiation therapy works by damaging the DNA molecules inside the cancer cell, thereby preventing them from being able to grow and divide. Generally, this treatment is done on an outpatient basis in a hospital or clinic. The type of radiation to be used is determined by the location of the tumor in the body.
External Beam Radiation
This type of radiation therapy involves lying on a table while a machine delivers a beam of radiation from the machine, through the skin, to the tumor. The most common machine is called a linear accelerator. The exact location for the beam to “hit” is determined by calculations during the “simulation” visit prior to the initiation of radiation therapy. The radiation is given over several days (often between 4 and 14 days), with each appointment lasting about 30 minutes. The actual dose of radiation is given for seconds to minutes, but it takes time to get you and the machine set up to deliver the precise dose of radiation ordered by your doctor. The total number of days is determined by the amount of radiation that your doctor wants to use. Some areas of your body are more sensitive and will not require as much radiation as others.
External beam radiation therapy is used commonly to treat bone metastasis causing pain or areas of bone that have been weakened by the cancer (to prevent the bone from breaking). These areas include the ribs, femur (the upper leg bone), humerus (the upper arm bone), and vertebrae (your backbones). If a fracture (break) occurs, radiation therapy may be given to kill cancer cells in the bone, allowing the fracture to heal. When kidney cancer spreads to the femur or humerus, surgery may be done to insert a metal rod to stabilize the bone with radiation therapy being given following surgery.
Side Effects of Radiation Therapy
Unfortunately, radiation may also damage healthy, normal tissue. Side effects of radiation therapy occur in the area treated, referred to as the “radiation field.” These side effects are temporary and vary depending on the area of the body being treated. One of the most common side effects is dry, irritated (reddened) and sensitive skin. Your radiation oncologist or nurse will provide you with written information and instructions for skin care and other side effects specific to your radiation treatments. The skin may require 6 to 12 months to return to normal.
Constipation or diarrhea may occur if the intestines are in the “radiation field.” Anemia (low hemoglobin), neutropenia (low white blood cell count), and thrombocytopenia (low platelet count) may occur if you are receiving radiation therapy to the pelvic bones or femur. Nausea, vomiting, and urinary discomfort may also occur.
Certain side effects occur during or shortly after the completion of radiation, while other side effects may begin several weeks after you have completed radiation therapy. Fatigue may develop towards the end or shortly after your treatments have finished. Fatigue is not unusual, but it is important to discuss the timing and severity of fatigue with your doctors and nurses. Resting is important, but doctors usually advise patients to stay as active as possible.
It is important to ask questions before treatment starts, at appointments, and during your recovery from radiation in order to ensure that your treatments are effective, side effects are minimal, and that any side effects that develop can be treated early. All of these factors will help you tolerate the treatment with a minimum of side effects and complications.
Radiosurgery is non-surgical technique that allows treatment of cancer that has metastasized to the brain. Doctors direct beams of high-dose radiation to tumors. This allows for a more precise and concentrated treatment than other types of radiation. Radiosurgery is the preferred method of treating brain tumors under a certain size and number.
One form of radiosurgery is gamma knife therapy for brain metastases. This is an outpatient procedure done in a gamma knife center, using a fitted head frame and both a CT and MRI scanner. The patient lies on a bed wearing the fitted head frame (helmet) that slides into the gamma knife machine. Radiation is delivered through ports inside the helmet, with the beams intersecting at the tumor.
Chemotherapy works on the same principles as radiation therapy except that chemicals are used to kill malignant cells or slow their growth. The specific type of chemotherapy depends on the site of metastases, type and grade of tumor, and physical condition of the patient. Many chemotherapy programs combine several different drugs to kill malignant cells that might be resistant to a single drug. Chemotherapy may be administered in a hospital or on an outpatient basis. The drugs may be taken by mouth, by intravenous infusion, or by simple injection.
Although chemotherapy is the standard treatment for most solid tumors, kidney cancer is generally resistant to chemotherapy.35 The reason for the resistance of kidney cancer cells to chemotherapy is not completely understood. However, it is now known that kidney cancer cells produce an overabundance of multidrug-resistance-associated protein, which acts to repel various chemotherapeutic agents away from the cancer cell.
5-Fluorouracil (5FU) appears to be the most effective chemotherapeutic agent currently available for kidney cancer, but response rates are only in the range of 5% to 8%.36 Therefore, at present, chemotherapy is generally used in combination with other therapies or reserved for patients entering clinical trials to test new agents and for patients who failed to respond to immunotherapy.37 Researchers continue to study new drugs, new drug combinations, and new treatment approaches.
As in radiation therapy, chemicals can damage normal cells. As a result, patients may experience side effects such as nausea, vomiting, diarrhea, rash, allergic reactions, and low white blood cell counts. The severity of these side effects depends on dosage, the specific drug used, the patient, the course of treatment, and other factors. These effects may last for a few hours to a few days.
Hormone therapy is a form of chemotherapy; however, in this case natural and synthetic hormones are used in place of cytotoxic drugs. There are generally fewer side effects from this type of therapy. Unfortunately, to date the use of hormonal therapy in the treatment of metastatic kidney cancer has yielded disappointing results.36 Hormone therapy is generally used to treat symptoms of the cancer rather than the cancer itself in a small number of patients with advanced kidney cancer.38 Megace (medroxyprogesterone) is an oral hormonal agent which may be used to help treat cancer-related anorexia, or loss of appetite.
Vaccine therapy is an experimental treatment that uses the patient’s own tumor cells or tumor-associated products to vaccinate the patient. The goal is to boost the body’s immune system in order to fight cancer. Unlike other vaccines, which are preventative, cancer vaccines are therapeutic; that is, they treat the disease rather than prevent it. Once you have had surgery to remove a tumor, a portion of it is used to create a vaccine that is then re-introduced into the body. It is hoped that these naturally occurring substances will stimulate the immune system to attack any new cells that re-appear bearing the original tumor’s genetic code. Vaccine therapy using tumor cells should be discussed as a treatment option before your nephrectomy.
Vaccine therapy is still in an investigational stage, with numerous research programs in progress. Early results were mixed, but as techniques have evolved, results have become more promising. Oncophage®, a vaccine manufactured by Antigenics, is approved for use in Russia, but has not been approved by the FDA.
Stem Cell Transplants
Blood stem cells reside in the bone marrow and perform the critical role of continually replenishing the body’s supply of red blood cells, white blood cells, and platelets. When transplanted, stem cells and T-Lymphocytes can elicit an anti-tumor effect under certain conditions.
This is a highly experimental procedure, and patients with advanced metastatic cancer who did not respond to interferon alfa K2 therapy have been treated with transplantation of peripheral blood stem cells.51 The results of this approach remain experimental, and because of the serious side effects experienced by some patients, further refinement of the procedure is needed.
Stem cell transplantation is an intensive procedure and is only recommended in limited situations. Check with your doctor.
Managing Your Expectations of Therapy
As you and your medical team consider options, including all of the treatment therapies listed here, it’s important to keep all of these options in perspective. Your doctor will make a recommendation to you based on a number of factors. It is important to understand why a particular treatment is chosen, so be sure to ask questions. If you are unable to afford these treatments, financial help is available. Call +1 847-332-1051 for information.
The state of your disease will be followed through the use of scheduled CT scans. Your doctor will discuss your results with you, indicating whether the tests show stabilization, partial response, complete response, or progression of the disease.
Each of us wants and needs to believe that we will be helped and “cured” by whatever therapy is used. The information you receive may cause disappointment. However, make certain that you talk to your doctor to ensure that you understand the meaning of terms like “partial response” and “stable disease.” These should be viewed as partial successes, not failure. Partial responses can help you determine when to change therapies — sometimes leading to other options that are more beneficial. Even if there is no response to a given therapy – a condition known as “stable disease” – this may put you in a holding pattern until a newer treatment or clinical trial is available. Kidney cancer is too unpredictable, and the therapies are too new, for you to give up fighting because of “stable disease” or “partial response.” For this reason, it is important not to let disappointment rob you of your determination or will to live. Simply learn from your experience and go on.