Systemic Therapy for Kidney Cancer

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We use different treatments if the kidney cancer has spread through the blood and started new growth in other places. Your care team will talk with you about options for systemic therapy.

Systemic therapy is when medications are given intravenously (through an IV) or as pills. These drugs travel in the blood to reach cancer cells in different parts of your body. You will see your care team regularly while on such treatment, in order to make sure you are doing well and to make any adjustments that are needed.

If you are getting systemic therapy for metastatic kidney cancer, you will have imaging with CT or MRI scans done every few months. These scans help your care team monitor how well treatment is working.

The 2 main types of systemic therapy for kidney cancers are molecularly targeted treatments and immunotherapy. Cytotoxic chemotherapies are common for other cancers. They do not work for most types of kidney cancer, and we rarely use them.
 

Targeted Therapy

Targeted therapies are a standard tool we use to manage kidney cancer that spread to other body parts (metastatic disease). Targeted therapies have been available since the mid-2000s. Many of the targeted therapies available today originally were tested in clinical trials by doctors at MSK. These drugs are based on our deep understanding of the molecular changes in this kind of cancer.

Targeted therapies work by focusing on activities that drive the growth of cancer cells. Some target blood vessels that supply nourishing blood to tumors. Others directly block proteins that make kidney tumors grow and spread. Almost all targeted drugs are pills that you take at home.

Immunotherapy

Drugs called checkpoint inhibitors are standard treatment to manage kidney cancer that has spread to other body parts (metastatic disease). Checkpoint inhibitors are immunotherapy drugs given to you by infusion through an intravenous (IV) line into your vein. They work by taking the brakes off the immune system and allowing your own immune cells to attack your cancer.

Many kidney cancers have a lot of immune cells that are “asleep.” This type of drug can reactivate, or wake up, the immune cells to fight cancer and attract additional immune cells from other parts of your body. These medications often work well against kidney cancer.

They are given intravenously and require regular visits to the clinic. Treatments usually are given in an outpatient setting, with no need for hospitalization.

Systemic Therapy with Drug Combinations

The strategy behind drug combination treatments is to attack the cancer from different angles at the same time. Some treatments combine targeted therapies (pills taken at home) with immune checkpoint inhibitors (drugs given by IV in the clinic). Other treatments may combine 2 targeted pills or 2 intravenous drugs.

MSK’s medical oncology team has deep knowledge about which drug or combination is best for the type of kidney cancer you have. They will talk with you about these treatments. After you start treatment, they will monitor you and make adjustments as needed.