Kidney Cancer: Immunotherapy and Targeted Therapy
What are immunotherapy and targeted therapy?
Immunotherapy and targeted therapy are treatments that use medicines to kill cancer cells or slow their growth. They're not the same as chemotherapy, which doesn't work well for kidney cancer. These medicines work in different ways and cause different side effects.
Immunotherapy is also called biologic therapy. This cancer treatment works with your body’s own immune system to find and kill cancer cells. These medicines boost, focus, or restore certain parts of the immune system.
Targeted therapy uses medicines that target specific parts of some cancer cells. They alter the cancer cells' ability to grow and survive. This treatment can block the growth and spread of cancer cells while limiting damage to healthy cells.
When might immunotherapy or targeted therapy be used for kidney cancer?
Your healthcare provider may suggest these treatments if the cancer has spread beyond your kidney or comes back after treatment.
There are different kinds of immunotherapy and targeted therapy medicines. Sometimes these treatments are used together.
Targeted therapy might be given after surgery if there's a high chance that the cancer will come back (recur). It can help lower this risk.
How are immunotherapy and targeted therapy given for kidney cancer?
These treatments may be given as pills, shots (injections), or right into your blood through an IV (intravenous) line.
Immunotherapy
There are 2 main groups of immunotherapy medicines: immune checkpoint inhibitors and cytokines.
Immune checkpoint inhibitors
These medicines help your immune system find and kill cancer cells. Sometimes kidney cancer cells use certain proteins, called checkpoints, to keep your immune system from attacking them. Medicines that block these checkpoints can boost your immune system against these cancer cells. This can shrink some tumors or slow their growth.
Immune checkpoint inhibitors that might be used include:
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Nivolumab
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Pembrolizumab
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Ipilimumab
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Avelumab
All of these are given as IV infusions every 2, 3, or 4 weeks.
Cytokines
Cytokines are proteins the body makes to help boost the immune system. Man-made versions of these proteins can be used to treat kidney cancer. They act like the natural proteins to turn on the immune system. They might be used if other immunotherapy medicines or targeted therapy don't work.
The cytokines that might be used are:
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Interleukin-2 (IL-2). Interleukin-2 is given as an IV infusion. Low doses may be given as outpatient therapy, but high doses work better. High-dose IL-2 can cause serious side effects. It's only given at cancer centers that have a lot of experience with this treatment.
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Interferon alpha. Interferon alpha doesn't work as well as IL-2. It's most commonly given along with the targeted therapy medicine called bevacizumab. It's common to take this medicine for many years, as long as it's working and the side effects aren't too severe. It's given as an injection a few times a week. You can get it as an outpatient at a hospital, clinic, or healthcare provider’s office. This means you go home the same day. Or you may learn how to give it to yourself at home.
Targeted therapy
Experts are still trying to figure out how to best way to use these medicines. They're often used one at a time. And if 1 medicine stops working, another might be tried.
Some kidney cancer cells are controlled by proteins, called tyrosine kinases, that help them grow. Some targeted therapies block these proteins so cancer cell growth slows or stops.
Kidney cancer cells also make a protein that fosters the growth of new blood vessels (called angiogenesis). These blood vessels are needed to get nutrients to the cancer cells so they can grow and divide. Blocking this process can keep tumors from growing.
Targeted therapy medicines used for kidney cancer are tyrosine kinase inhibitors, angiogenesis inhibitors, or both. These are most commonly used:
What are possible side effects of immunotherapy and targeted therapy ?
Even though some of these medicines are pills you take at home, like most types of cancer treatment, they can cause side effects. Some can be severe. Side effects depend on the type and dose of medicines you’re taking.
Side effects tend to get better over time after treatment ends. They vary from person to person. Many of them can be treated to keep them from getting worse. It's important to tell your treatment team about any changes you notice while getting immunotherapy or targeted therapy.
Possible side effects include:
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Appetite loss
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Mouth sores
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Extreme tiredness and weakness
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Headaches, muscle aches, joint aches, or bone pain
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Nausea and vomiting
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Skin rash or dryness, itching
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Pain, redness, swelling, and blistering of the skin on your palms and the soles of your feet (called hand-foot syndrome)
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Changes in skin and/or hair color
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Constipation
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Fluid buildup that may cause swelling
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Easy bleeding and bruising
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Low thyroid hormone levels
Serious side effects can include:
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Changes in mental function
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Low or high blood pressure
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Diarrhea
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Pain in the belly (abdomen)
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Chills with a high fever
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High blood sugars
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Fast heartbeat
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Heart rhythm changes
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Slow wound healing
Other, less common, but severe side effects are possible, such as:
In rare cases, some of these side effects can be fatal. Because of the risk of severe side effects, these treatments are not an option for everyone. They're used to treat kidney cancer only in people who are in good overall health and who can cope with treatment-related problems.
Working with your healthcare provider
It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.
Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, many of these medicines can cause diarrhea. You may be told to drink a lot of fluids, not eat high-fiber foods, and call if you have 4 or more loose bowel movements a day for more than 2 days.
Make sure you know what number to call with questions or problems. Is there a different number to call after hours when the clinic is closed?
It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.