Other Treatment Approaches for Kidney (Renal Cell) Cancer

This content has been reviewed and approved by

Robert J. Motzer, MD
Attending Physician

Memorial Sloan-Kettering Cancer Center

Targeted Therapies

Targeted therapies are medications that block or attack specific cell processes that the kidney cancer cells need to survive and grow. These therapies are developed based on a detailed knowledge of the cell biology of kidney cancer. Nexavar® (sorafenib), Sutent® (sunitinib), and Torisel™ (temsirolimus) are approved in the United States for use in advanced renal cell cancer. These and other possible targeted therapies that are now under study offer new possibilities for treatment and are of great interest to many physicians who treat renal cell cancer.

Immunotherapy

Sometimes surgery is too risky. If so, your doctor may recommend immunotherapy (treatment to boost the immune system) first. If this treatment is effective, your doctor may then recommend that you have surgery to remove any remaining tumor.

Immunotherapy stimulates your immune system to attack cancer. The goal is to get your own immune system to get rid of cancer in much the same way it gets rid of the flu. Immunotherapy agents doctors use most often are Proleukin® (aldesleukin) and interferon.

Aldesleukin is approved by the Food and Drug Administration (FDA) for the treatment of metastatic kidney cancer. Approximately 20 percent of patients respond to immunotherapy and have some degree of tumor regression (shrinking). About 7 percent of patients have complete cancer regression.

Among the many different immunotherapy regimens, one of the most effective is high-dose aldesleukin, which requires inpatient hospitalization. During the initial hospitalization, intravenous (by a needle into the vein) patients receive aldesleukin during a period of 5 days. A patient usually goes home for a rest period of 5 to 10 days. Then, the patient comes back to the hospital for another 5-day course of intravenous aldesleukin.

The most common side effects of immunotherapy are similar to flu symptoms and include fever, chills, nausea, vomiting, diarrhea, and fatigue. Other side effects include low blood pressure, fluid accumulating in the lungs (pulmonary edema), problems with liver function and kidney function, mental status changes (confusion, agitation, disrupted sleep pattern), and rapid and irregular heart beat. Most side effects are temporary and disappear when therapy stops.

To be a candidate for immunotherapy, you must be in good general condition, have fairly good function of vital organs (such as the heart, lungs, and kidneys), and have no brain metastasis. Immunotherapy is not effective against cancer in the brain. Before immunotherapy, you will need tests to assess vital organ function and a scan (x-ray picture) to see if brain metastases are present.

Nephrectomy and Immunotherapy

If you have metastases (areas of cancer outside the kidney), your best chance of survival comes from removing the affected kidney before receiving immunotherapy. Your doctor may remove your kidney by open or laparoscopic surgery. Your doctor will offer you this treatment option only if you are a candidate for both nephrectomy and immunotherapy.

You should not have any treatment until an oncologist (cancer expert) who specializes in immunotherapy and a urologic surgeon evaluate you. And you should only receive this treatment after the surgeon and oncologist agree that you're a candidate for both nephrectomy and immunotherapy.

Tumor Ablation

Tumor ablation is a process that destroys a tumor without having to remove it surgically. Examples of ablative technologies include cryotherapy (freezing), interstitial radiofrequency (a technique using sound waves), high intensity focused ultrasound (using sound waves), microwave therapy (using microwaves), and laser coagulation (using a laser).

Your doctor may perform an ablation during open surgery, laparoscopy, retroperitoneoscopy (through the space around the kidney), or percutaneously (through the skin). Because renal tumor ablation is a relatively new procedure, long-term results are unknown. However, ablation may be less invasive than nephrectomy and may be useful in patients who cannot tolerate a more extensive surgery. Tumor ablation may also permit a better chance of preserving kidney function when multiple tumors are present.

Embolization

Your doctor may consider adding this treatment to other standard forms of treatment, especially if your tumor is actively bleeding. Embolization can stop the bleeding and allows your doctor to stabilize you before surgery. Your doctor usually performs embolization while you are under sedation.

In this procedure, your doctor threads a long, narrow tube (catheter) from an artery (such as in the groin) into the artery of the kidney. The doctor then deposits small particles in the vessels of the kidney. These particles block the flow of blood to the tumor and therefore stop any active bleeding. Furthermore, without a blood supply, the tumor eventually dies. Because it is unclear whether or not embolization completely eliminates the tumor, it is not considered a primary form of therapy for kidney cancer.

Surveillance

Surveillance or watchful waiting is an option mostly for patients who do not wish to undergo treatment or patients who cannot tolerate treatment. Surveillance typically consists of periodic assessments by your physician, including blood tests and x-rays. There are no standard surveillance rules; therefore, your physician will determine the necessary tests and their timing based on your unique situation.

Clinical Research Trials

Research trials are not available to everyone. If you're interested in finding out more about these trials, you can:

• Ask your doctor
• Check with your local hospital or medical center
• Search the National Institutes of Health database on the Internet
  

There are many nonstandard therapies that researchers are using and studying in clinical trials. Some of these treatments include advances in surgical techniques, approaches for tumor ablation (cell destruction), new targeted therapies and combinations of new targeted therapies. Although these therapies appear promising, they are still experimental and it is unclear whether or not they are effective treatments for kidney cancer.

Your Prognosis

There are many factors that affect how well treatment for kidney cancer will help you. The two most important factors for your prognosis (outcome) are tumor stage and grade. The lower the stage and grade, the easier it is to achieve a cure with treatments known today. This is because a lower stage means the cancer has not yet progressed to the most advanced state possible, and a lower grade means the cancer cells are not as abnormal (and may not be as aggressive) as is possible.