Renal Cell Cancer (cont.)

Medical Author:

Kush Sachdeva, MD

Coauthor:

Brendan Curti, MD

Medical Editor:

Winston W Tan, MD

Medical Editor:

Mary L Windle, PharmD

Medical Editor:

Koyamangalath Krishnan, MD, FRCP

Medical Treatment

Treatment of renal cell cancer depends on the stage of the disease and the person's overall health, which determines how well that person is able to tolerate various therapies. A medical team will devise a treatment plan that is tailored specifically for the individual. Therapies that are used for renal cell cancer include surgery, chemotherapy, biological therapy, hormone therapy, and radiation therapy.Clinical trials (tests of new medicines) may be appropriate for some patients with kidney cancer. A person may undergo a single therapy or a combination of therapies.

Generally, surgery is the best treatment for renal cell cancer that has not metastasized. For more information,see Surgery.

Chemotherapy is the use of strong drugs to kill cancer cells.

• Unfortunately, chemotherapy has less benefit in renal cell cancer than other cancer diagnoses.
  
  
• Chemotherapy shrinks the tumor in some patients with kidney cancer, but this period of remission does not usually last long.
  
  
• Chemotherapy drugs may be given singly or in combinations.
  
  
• Chemotherapy typically has side effects such as nausea and vomiting, weight loss, and hair loss. Chemotherapy can also suppress production of new blood cells, leading to fatigue, anemia, easy bruising or bleeding, and increased risk of infection.

Hormone therapy involves taking a hormone to kill cancer cells. Several different hormone preparations have been tried in renal cell cancer in the past, but these agents are less effective than chemotherapy and are no longer used frequently.

Biological therapy, sometimes called immunotherapy, tries to boost the body's own immune system to fight and kill the cancer, by using substances made naturally by the body. These substances are copied in a laboratory and injected into the body.

• Biological therapy is often reserved for metastatic renal cell cancers that cannot be cured by surgery.
  
  
• The most successful immunotherapy drugs in metastatic renal cell cancers are interleukin-2 (IL-2) and interferon alfa (IFNa).
  
  
• These agents have side effects that can be very severe, including high fevers and chills, dangerously low blood pressure, fluid around the lungs, kidney damage, intestinal bleeding, and heart attacks. Despite these problems, selected patients can tolerate these treatments and can achieve prolonged remissions. For instance, some patients are alive 15 years or longer after having received high-dose IL-2 for metastatic kidney cancer.
  
  
• Because lower doses of medications cause fewer and less severe side effects, low doses of these agents are being tested in combination with each other, with other cytokines and immune cells, and with chemotherapy drugs.
  
  
• Many areas of research are active in kidney cancer treatment, including investigation of agents that block blood vessel formation (necessary for growth of the kidney cancer), drugs that block division of kidney cancer cells, vaccines, and new drugs that boost the immune system.

Radiation therapy uses a high-energy radiation beam to kill cancer cells. Renal cell cancers typically are resistant to radiation. Some people undergo radiation therapy after surgery to kill tumor cells that remain. Radiation therapy is often used to relieve symptoms in persons with metastatic disease or who cannot undergo surgery because of other medical conditions.

Because metastatic renal cell cancer is largely incurable with currently available forms of systemic therapy, patients with metastatic renal cell cancer are encouraged to discuss innovative clinical trials with their physicians before making a final decision.