Targeted Therapies for Kidney Cancer
As researchers have learned more about the molecular and genetic changes in cells that cause cancer, they have developed newer drugs that target some of these changes. These targeted drugs are different from standard chemotherapy drugs. They sometimes work when standard chemo drugs don’t, and they often have different (and less severe) side effects. Targeted drugs are proving to be especially important in kidney cancer, where chemotherapy has not been shown to be very effective.
These drugs are often used as the first line of treatment against advanced kidney cancers. They can often shrink or slow the growth of the cancer for a time, but it doesn’t seem that any of these drugs can actually cure kidney cancer.
Several targeted drugs can be used to treat advanced kidney cancer. These drugs block angiogenesis (growth of the new blood vessels that nourish cancers) or important proteins in cancer cells (called tyrosine kinases) that help them grow and survive. Some targeted drugs affect both of these.
Doctors are still learning the best ways to use targeted drugs against advanced kidney cancers. As of now, they are most often used one at a time. If one doesn’t work, another can be tried. It’s not yet known if any one of these drugs is clearly better than the others, if combining them might be more helpful than giving them one at a time, or if one sequence is better than the other. Studies are being done to help answer these questions.
Sorafenib acts by blocking both angiogenesis and growth-stimulating molecules in the cancer cell itself. Sorafenib does this by blocking several tyrosine kinases that are important for cell growth and survival. It is taken as a pill twice a day.
The most common side effects seen with this drug include fatigue, rash, diarrhea, increases in blood pressure, and redness, pain, swelling, or blisters on the palms of the hands or soles of the feet (hand-foot syndrome).
Sunitinib also blocks several tyrosine kinases, but not the same ones as sorafenib. It attacks both blood vessel growth and other targets that help cancer cells grow. This drug is taken as a pill.
The most common side effects are nausea, diarrhea, changes in skin or hair color, mouth sores, weakness, and low white and red blood cell counts. Other possible effects include tiredness, high blood pressure, congestive heart failure, bleeding, hand-foot syndrome, and low thyroid hormone levels.
Temsirolimus works by blocking a cell protein known as mTOR, which normally helps cells grow and divide. This drug has been shown to be helpful against advanced kidney cancers that have a poorer prognosis because of certain factors. It is given as an intravenous (IV) infusion, typically once a week.
The most common side effects of this drug include skin rash, weakness, mouth sores, nausea, loss of appetite, fluid buildup in the face or legs, and increases in blood sugar and cholesterol levels. Rarely, more serious side effects have been reported.
Everolimus also blocks the mTOR protein. It is used to treat advanced kidney cancers after other drugs such as sorafenib or sunitinib have been tried. Everolimus is taken as a pill once a day.
Common side effects of this drug include mouth sores, an increased risk of infections, nausea, loss of appetite, diarrhea, skin rash, feeling tired or weak, fluid buildup (usually in the legs), and increases in blood sugar and cholesterol levels. A less common but serious side effect is lung damage, which can cause shortness of breath or other problems.
Bevacizumab is an IV drug that works by slowing the growth of new blood vessels. It may help some people with kidney cancer when used with interferon-alfa.
More common side effects include high blood pressure, tiredness, and headaches. Less common but possibly serious side effects include bleeding, blood clots, holes forming in the intestines, heart problems, and slow wound healing.
Pazopanib is another drug that blocks several tyrosine kinases involved in cancer cell growth and the formation of new blood vessels in the tumor. It is taken as a pill once a day.
Common side effects include high blood pressure, nausea, diarrhea, headaches, low blood cell counts, and liver problems. It can cause lab test results of liver function to become abnormal, but it rarely leads to severe liver damage that can be life threatening. Problems with bleeding, clotting, and wound healing can occur, as well. It also rarely causes a problem with the heart rhythm or even a heart attack. If you are taking this drug, your doctor will monitor your heart with EKGs as well as check your blood tests to check for liver or other problems.
Axitinib also inhibits several tyrosine kinases, including some that are involved in the formation of new blood vessels. It is typically used after at least one other treatment has been tried. Axitinib is taken as a pill twice a day.
Common side effects include high blood pressure, fatigue, nausea and vomiting, diarrhea, poor appetite and weight loss, voice changes, hand-foot syndrome, and constipation. High blood pressure requiring treatment is fairly common, but in a small number of patients it can get high enough to be life-threatening. It can also cause problems with bleeding, clotting, and wound healing. In some patients, lab test results of liver function can become abnormal. Axitinib may also cause the thyroid gland to become underactive, so your doctor will watch your blood levels of thyroid hormone while you are on this drug.
Cabozantinib is another drug that blocks several tyrosine kinases, including some that help form new blood vessels. It is typically used after at least one other treatment has been tried. Cabozantinib is taken as a pill once a day.
Common side effects include diarrhea, fatigue, nausea and vomiting, poor appetite and weight loss, high blood pressure, hand-foot syndrome, and constipation. Less common but more serious side effects can include serious bleeding, blood clots, very high blood pressure, severe diarrhea, and holes forming in the intestines.
Lenvatinib (Lenvima) is another kinase inhibitor that helps block tumors from forming new blood vessels, as well as targeting some of the proteins in cancer cells that normally help them grow. It is typically used along with everolimus after at least one other treatment has been tried. Lenvatinib is taken as capsules once a day.
Common side effects include diarrhea, fatigue, joint or muscle pain, loss of appetite, nausea and vomiting, mouth sores, weight loss, high blood pressure, and swelling in the arms or legs. Less common but more serious side effects can include serious bleeding, blood clots, very high blood pressure, severe diarrhea, holes forming in the intestines, and kidney, liver, or heart failure.
Last Medical Review: February 24, 2014 Last Revised: May 16, 2016
- Surgery for Kidney Cancer
- Ablation and Other Local Therapy for Kidney Cancer
- Active Surveillance for Kidney Cancer
- Radiation Therapy for Kidney Cancer
- Targeted Therapies for Kidney Cancer
- Biologic Therapy (Immunotherapy) for Kidney Cancer
- Chemotherapy for Kidney Cancer
- Pain Control for Kidney Cancer
- Treatment Choices by Stage for Kidney Cancer