Treatment
Surgery is the primary treatment for stage 1, 2, and 3 kidney cancer whenever possible. After surgery, treatment may include one year of immunotherapy for select patients with stage 2 and 3 kidney cancer with the goal of decreasing the risk of your cancer recurring. In more advanced stages of kidney cancer, your doctor may recommend systemic therapy, such as targeted therapy or immunotherapy, as primary treatments. For some patients with advanced stages of kidney cancer, your doctor will recommend surgery to remove the kidney cancer either before or during systemic therapy. Traditional chemotherapy is not very effective against kidney cancer. Your doctor may try chemotherapy for certain rare types of advanced kidney cancer, or give you palliative radiation treatments to relieve symptoms. Here are some procedures commonly used to treat kidney cancer:
Radical Nephrectomy
A nephrectomy, or surgery to remove all or part of the kidney, is the primary treatment for kidney cancer. Your surgeon may be able to perform this surgery laparoscopically, making only three or four small incisions in your abdomen and passing surgical instruments through the cuts to remove the kidney. In a radical nephrectomy, your surgeon removes the entire kidney and surrounding fatty tissue. Your surgeon may also remove the adrenal gland and nearby lymph nodes. You can live with one kidney, but if both kidneys fail you will need dialysis or a kidney transplant.
Partial Nephrectomy
In a partial nephrectomy, your surgeon removes only the kidney tumor and a margin of healthy tissue around it. Whether you need a partial or radical nephrectomy depends on the location of the tumor, but tumor size is not a huge factor anymore. Partial nephrectomies may be performed for any size tumor, as long as the tumor is amenable.
Energy ablation
There are a few other minimally invasive procedures used to treat small kidney tumors in patients unable or unwilling to undergo surgery. These procedures use heat and cold to destroy the tumor without having to surgically remove the kidney.
Cryoablation – Your doctor inserts a long, thin probe into the tumor and shoots cold gases through the probe to freeze and destroy the tumor.
Radiofrequency ablation (RFA) – Your doctor inserts a long, thin probe into the tumor and passes an electric current through the probe to kill the tumor with heat.
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Arterial embolization
Doctors sometimes perform this procedure to shrink the tumor before surgery and to reduce bleeding during the operation. Your doctor injects material into the artery that supplies blood and oxygen to the tumor. This cuts off the blood supply to the tumor, causing it to shrink and die.
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Systemic Therapy for Kidney Cancer
Systemic therapy refers to medications that you receive by mouth or through a large vein and treat cancer throughout your body. Systemic therapy is most frequently used for patients with stage 4 kidney cancer. Additionally, it is now used after nephrectomy for select patients with stage 2 or 3 kidney cancer. For patients with kidney cancer, the most common classes of systemic therapy are targeted therapy and immunotherapy. Targeted therapy and immunotherapy may be used alone (one medication) or in combination (two medications) to treat kidney cancer.
Targeted therapy
Targeted therapy is one of the primary systemic treatments for advanced kidney cancer. Kidney tumors create new blood vessels to support their growth. Targeted therapy attacks this process, called angiogenesis, and prevents the growth of new blood vessels. This therapy may shrink the tumor or slow its growth, but it does not cure the disease when given alone. Targeted therapies that are commonly prescribed for advanced kidney cancer include cabozantinib, lenvatinib, axitinib, sunitinib, pazopanib, tivozanib, and everolimus. Additionally, a new targeted therapy, belzutifan, that uniquely targets angiogenesis is approved for the treatment of patients with either spordiac clear cell RCC or kidney cancer due to a specific inherited disease, von Hippel-Lindau.
Immunotherapy
Immunotherapy stimulates your body's immune system to help it fight off cancer. Historically, immunotherapy with IL2 was used for select patients with advanced kidney cancer, but is no longer used given serious side effects and benefit in only a small subset of patients. Now, we use monoclonal antibodies to target the immune checkpoints PD-1, and CTLA-4. These monoclonal antibodies target proteins in the body that prevent the immune system from attacking cancer cells. Blocking these proteins allows the immune system to target and destroy cancer cells. Monoclonal antibodies targeting these immune checkpoints may be used in combination with angiogenesis targeted therapy, such as pembrolizumab plus axitinib, nivolumab plus cabozantinib, or pembrolizumab plus lenvatinib. Monoclonal antibodies that target different immune checkpoints may be used in combination, specifically nivolumab plus ipilimumab. Finally, the PD-1 checkpoint inhibitor, nivolumab, may be used alone after treatment with targeted therapy.
Clinical trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
