Kidney Cancer Treatment
There are a variety of treatment options available to treat kidney cancer. However, the treatment option depends on the level of progression of the cancer. A combination of treatments may also be used. Treatment options include surgery, radiotherapy, chemotherapy, immunotherapy, target drugs and clinical trials.
Select a treatment type to skip to that section:
Surgery
Renal cancer that has not metastasized, and therefore remains localized to the kidney, is usually treated with surgery — chemotherapy and radiation treatment are not necessary. The surgical management of the kidney involves either the removal of the entire kidney or only parts of the kidney affected by cancer. The type of surgery is dependent on the progression of the cancer.
Simple Nephrectomy: An operation which removes the kidney and the tumour within it.
Partial Nephrectomy: An operation which only removes the tumour in the kidney and some healthy tissues around it. This surgery is done to keep the in place, and to optimize the function of the working kidney.
Radical Nephrectomy: An operation that removes the kidney with the tumour, the lymph nodes, the adrenal gland and the ureter.
There are different techniques that are applied depending on where the tumour is located. The surgery may be completed as an open surgery, a laparoscopic surgery or a robotic surgery.
Open Surgery: A large surgical cut between the lower ribs is made to reach the kidney. Open surgeries may be completed for tumours that are larger in size or have grown to veins. It can be more painful and has a longer recovery time.
Laparoscopic Surgery: also called minimally invasive surgery (MIS), involves making only small incisions through which tubes containing thin surgical instruments and a camera are inserted into a patient’s body in order to perform the surgery. This approach has many advantages over traditional surgery, including shorter recovery times and hospital stays, less post-operative discomfort, and reduced external and internal scarring.
Robotic Surgery: A new technique that has advanced in Canada where the tissue and tumour is removed through 2 or 3 robotic arms that are controlled by the surgeon. Robotic surgery is very advanced but allows surgeons to remove cancerous tissue more accurately than a standard laparoscopy.
Ablative treatment approaches such as radiofrequency ablation have advantages over other surgical techniques for treating kidney cancer, including a reduction in post-operative complications, shorter hospital stays, and faster recovery times.
Radiofrequency ablation: A minimally invasive method employs a small needle attached to a device that emits radiofrequency energy in the form of heat. The needle is inserted into a tumour laparoscopically (usually under computed tomography (CT) or ultrasound guidance) while the patient is under sedation or general anesthesia. A high-frequency alternating current then passes through the needle, heating up the tip to temperatures exceeding 60ºC and causing coagulative necrosis of the surrounding cancerous tissue, thereby destroying it. Once a target temperature has been reached, cancerous tissue will then often be treated with multiple cycles of radiofrequency ablation during the procedure.
Cryoablation: This technique employs one or more ‘cryoprobes’ (specialized needles) and a temperature probe that are inserted through small incisions in the skin and into a tumour while the patient is under sedation or general anesthesia. The cryoprobes are attached to a device that generates a gas that passes through the needle, generating extreme cold at the tip. The extreme cold causes and ice ball to form and the cancer cells surrounding the tip of the needle(s) freeze and die. To ensure complete cell destruction, the temperature must reach a certain critical threshold that is unique to the type of cells comprising the target cancer tissue, and usually ranges between -20 ºC and -50ºC. Cryoablation offers the advantage of targeted cell death by using multiple cycles of tumour freezing and thawing during a procedure while sparing the surrounding tissues; which is especially important in patients who may already have reduced renal function.
Radiotherapy
Radiation therapy involves focusing an external beam of radiation directly on a tumour to kill the cancerous cells. This option is sometimes used in the treatment of reoccurring renal cancers or painful bone metastases.
Side Effects:
Possible side effects include fatigue, nausea, vomiting, diarrhea, discomfort when urinating, compromised immune system, and skin irritation of the treated area. Such side effects are often controllable to an extent.
Chemotherapy
Chemotherapy involves the use of drugs to target and kill cancerous cells, but it is not very effective in treating most kidney cancers. Chemotherapies work by attacking all the rapidly dividing cells in the body. This means that, aside from killing cancerous cells, chemotherapies also end up attacking healthy cells such as blood cells, hair root cells, and digestive tract cells.
Side Effects:
Side effects of this type of treatment vary depending on the specific drug and dosage given, but may include increased bruising and bleeding, fatigue and weakness, hair loss, loss of appetite, nausea, vomiting, and diarrhea. Again, some of these side effects can be controlled to an extent with drugs.
Immunotherapy
Immunotherapies are aimed at initiating or boosting the body’s natural immune response against cancerous cells and can be effective in the management of advanced kidney cancer. Immune checkpoint inhibitor therapy involves blocking proteins on the tumour from functioning so immune cells can kill the cancer cells on the tumour. Immunotherapy drugs include Nivolumab, Pembrolizumab, Atezolizumab, Duravlumab, Avelumab, Ipilimumab and Interleukin-2.
Side effects:
Side effects include flu-like symptoms, nausea, diarrhea, low blood pressure (hypotension), decreased urine production, fatigue, and depression.
Target Therapy
Targeted therapies focus on the specific molecular pathways that lead to the growth and spread of kidney cancer and are proving to be invaluable in the medical management of this disease. Many targeted therapies act through anti-angiogenesis, which involves the inhibition of the growth and proliferation of blood vessels supplying tumours. In some cases, such drugs may begin to be administered before surgery in order to minimize the growth of blood vessels surrounding the tumour(s) that are to be removed.
Targeted therapies are constantly being investigated in research. The current targeted therapies available for managing kidney cancer are listed below.
VEGF Targeted: These drugs are able to inhibit angiogenesis and other factors which stimulate the growth and spread of kidney cancer cells.
Sunitnib (Sutent): Sutent is taken orally at 50mg for 4 weeks, and then there is a 2 week interval where Sutent is not taken.
Sorafenib (Nexavar): Nexavar is a 200mg pill that is taken twice daily
Bevacizumab (Avastin): Avastin is taken orally for 2 week intervals at 10mg/kg.
Interleukin-2 (Proleukin): It can also be used in immunotherapy and is taken through an IV. There is a 15 minute IV infusion every 8 hours for 14 doses.
Pazopanib (Votrient): Votrient is taken orally once a day at 800mg
Axitinib (Inlyta): Inlyta is to only be used when another form of target therapy has not worked. It is taken orally twice a day at 5mg.
Dovitinib (TKI-258): Taken orally at 500mg, 5 days a week.
Tivozanib (Tivopath): Taken orally at for 3 weeks at 1.5mg.
mTOR Targeted: These drugs are able to inhibit angiogenesis, prevent the growth of new vessels and block the growth of the tumours which need the vessels to grow.
Temsirolimus (Torisel): Torisel is taken at 25mg in an IV infusion once a week for 30 minutes. It involves a pre-treatment of 25-50mg antihistamines
Everolimus (Afinitor): Afinitor is used if Sunitinib or Sorafenib fails. It is a 10mg oral pill taken daily
Other TKI targeted: These drugs also inhibit the tyrosine kinase protein which prevents angiogenesis.
Cabozantinib (Cabometyx): Cabometyx is taken for advanced RCC patients who have already received antiangiogenic therapy. It is taken orally at 60mg once daily.
Lenvatinib (Lenvima): Lenvima is taken in combination with everolimus for advanced RCC patients who were treated with 1 prior to anti-angiogenic therapy. It is taken orally at 18mg with 8mg of everolimus daily.
Crizotinib (Xalkori): Taken for patients with metastatic non-small cell lung cancer who have the presence of ALK or ROS1 in their tumour specimens. It is taken twice daily at 250mg
Savolitinib (Voltinib): Voltinib is a MET inhibitor and is taken orally at 25mg once daily. It is being tested in patients with papillary RCC.