Strategies to Improve Treatment for Stage II Kidney (Renal Cell) Cancer

This content has been reviewed and approved by

Robert J. Motzer, MD
Attending Physician

Memorial Sloan-Kettering Cancer Center

Surgery

Surgery for stage II renal cell cancer is usually the best treatment option because it is most likely to offer a chance for a cure. Surgeons are continually refining their surgical techniques to reduce the risk of complications and spare as much kidney function as possible. It is best to choose a surgeon who is well-qualified in this area and performs a large number of operations for renal cell cancer each year.

Adjuvant Treatment Options

Adjuvant treatment is a treatment your doctor uses to prevent your cancer from coming back. Currently, there is much ongoing research into adjuvant treatment approaches, such as biologic modifiers and new targeted therapies. However, the benefit of adjuvant treatment for stage II renal cell cancer has not been established.

Targeted Therapies

Targeted therapies are medications that block or attack specific cell processes that kidney cancer cells need to survive and grow. These therapies are developed based on a detailed knowledge of the cell biology of kidney cancer. Sutent^® (sunitinib), Nexavar^® (sorafenib), and Torisel^TM (temsirolimus) are approved in the United States for use in renal cell cancer.

Sutent (sunitinib)

• Sunitinib is a drug that fights tumors by suppressing cell growth and blood vessel development. It is a pill given by mouth. Studies of sunitinib have shown that it shrinks kidney tumors in some patients, and prevents tumors from growing larger in certain others. More studies of the use of sunitinib in renal cell cancer are ongoing.
• A large study published in 2007 showed that patients treated with sunitinib had a longer time period before their cancer progressed than patients treated with an older treatment—alpha interferon. The study evaluated 750 patients with metastatic renal cell cancer who had not been treated before. In the study, sunitinib gave patients an average of about 11 months before their tumors started growing again, compared with about 5 months for alpha interferon. Patients treated with sunitinib were also more likely to respond to treatment, and had a better quality of life.
• Sunitinib may cause side effects, such as diarrhea, nausea, indigestion, vomiting, skin discoloration, loss of normal skin or hair color, or a skin reaction on the palms of the hands or soles of the feet. Patients taking sunitinib may also be at higher risk of bleeding, heart failure, damage to the adrenal gland (a gland located near each kidney), or very high blood pressure. Women should not become pregnant or breast-feed while taking sunitinib because of risks to the unborn or nursing baby.

Nexavar (sorafenib)

• Sorafenib is a drug that prevents cell growth and blood vessel development. It is a pill given by mouth. Sorafenib has been studied in patients with advanced renal cell cancer. Researchers have shown that in patients taking sorafenib, it takes longer for advanced renal cell cancer to grow and become more severe. Additional studies to understand how sorafenib may be used against renal cell cancer are under way.
• In a large study published in 2007, patients treated with sorafenib were found to live longer without cancer growth, compared with a placebo (an inactive treatment). The patients had already been treated unsuccessfully with standard therapies, and all patients on the placebo were offered sorafenib after the first survival analysis showing its benefit was completed. The study evaluated 903 patients with metastatic renal cell cancer. On average, sorafenib gave patients about 5 months before tumor growth began, compared with about 3 months for the placebo.
• Sorafenib may cause side effects, such as diarrhea, rash, tiredness, or a skin reaction on the palms of the hands or soles of the feet. In addition, patients taking sorafenib may have a higher risk of bleeding, heart attack, or very high blood pressure. Women should not become pregnant while taking sorafenib because it may harm the unborn baby.

Torisel (temsirolimus)

• Temsirolimus interrupts the cell cycle, preventing cancer cell division and the formation of new blood vessels. It is an injectable drug that is administered through a vein over a 30- to 60-minute period once per week. While studies continue, temsirolimus has been found to be effective compared with alpha interferon in the treatment of advanced renal cell cancer.
• In a large study of 626 patients with advanced renal cell cancer, treatment with temsirolimus was compared with alpha interferon. The patients who participated in the study had not yet been treated with a course of drug therapy for their cancer, and had confirmed diagnoses of either stage IV or recurrent (returning) renal cell carcinoma with a poor prognosis (prediction of recovery from cancer). Temsirolimus was found to help patients live longer without cancer growth compared with alpha interferon (10.9 months compared with 7.3 months) and to prevent cancer progression for longer than alpha interferon. Fewer patients in the temsirolimus group had serious adverse events. Using a combination of temsirolimus and alpha interferon did not appear to improve treatment results.
• Patients receiving temsirolimus may have side effects, including rash, weakness, inflammation of the mucous membranes lining the digestive tract (experienced as sores in the mouth or elsewhere), nausea, tissue swelling, and loss of appetite. Temsirolimus may increase blood sugar to the point where medication is necessary; patients should tell their doctor if they notice an increase in thirst or urination with temsirolimus. Temsirolimus may interfere with wound healing, and caution is needed to avoid using temsirolimus too soon after surgery. Because temsirolimus may cause side effects involving the liver, kidneys, and other major organs, patients should review precautions with their doctor and tell their doctor about any unusual symptoms right away. Both women and men should not conceive a child during and for 3 months after treatment with temsirolimus because of the risk of harm to the unborn baby.
  

• Avastin^® (bevacizumab), another type of targeted therapy, is already available in the United States for other types of cancer. Researchers are studying this drug for renal cell cancer because of its ability to block the formation of new blood vessels needed for tumors to grow. 

Biologic Modifier Therapy

Biologic response modifiers are naturally occurring or created substances that direct or help your body's normal immune defenses. The goal of biologic therapy is to get your immune system to launch an attack on cancer cells.

Biologic response modifiers include:

• Interleukins - substances that stimulate certain kinds of white blood cells to grow
  
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  • Proleukin^® (aldesleukin) - Aldesleukin is a biologic response modifier approved for the treatment of advanced renal cell cancer, and a commercial form of interleukin-2. Clinical trials showed that aldesleukin achieved a long-standing response in 5 percent of patients with advanced renal cancer.
  
  
• Monoclonal (laboratory-created) antibodies - disease-fighting elements of your immune system.
• Interferons - substances that the body produces naturally to help fight infections and tumors
  
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  • Alpha interferon (also known as interferon-alpha) - a mixture of substances imitating the structure and action of natural interferon. Alpha interferon may help the body recognize and destroy other types of cancer cells, but is associated with severe side effects.