Treatment & Management

of Renal Cell Cancer

Treatment for renal cell cancer is tailored to each individual and may include surgery, precision cancer medicines, immunotherapy and chemotherapy. Radiation therapy is not typically used for the treatment of renal cell cancer. The specific treatment depends on the stage and genomic profile of the cancer.

Surgery. Patients with early stage renal cell cancer are curable with surgical removal of the cancer. Partial nephrectomy, which is removal of only the cancer and a small border of normal tissue, is the standard treatment for the smallest cancers however patients will require a radical nephrectomy, or removal of the entire kidney for larger renal cell cancers.

Systemic Therapy: Precision Cancer Medicine, Chemotherapy, and Immunotherapy

Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Some patients with early stage cancer already have small amounts of cancer that have spread outside the kidney. These cancer cells cannot be treated with surgery alone and require systemic treatment to decrease the chance of cancer recurrence. More advanced cancers that cannot be treated with surgery can only be treated with systemic therapy.

Systemic therapies commonly used in the treatment of renal cell cancer include:

Chemotherapy

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. The drugs are usually given in cycles so that a recovery period follows every treatment period.

Most chemotherapy drugs cannot tell the difference between a cancer cell and a healthy cell.  Therefore, chemotherapy often affects the body’s normal tissues and organs, which can result in complications or side effects. In order to more specifically target the cancer and avoid unwanted side effects researchers are increasingly developing precision cancer medicines.

Precision Cancer Medicines

The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are being developed for the treatment of renal cell cancer, and patients should ask their doctor about whether testing is appropriate.

Immunotherapy

Immunotherapy works by stimulating the immune system to fight the cancer. Historically the most frequently used types of immunotherapy to treat renal cell cancer were Proleukin® (interleukin-2) and alfa interferon, however newer precision cancer immunotherapy drugs called “checkpoint inhibitors” appear promising and are being incorporated into treatment strategies.1,2,3,4

Treatment of Renal Cell Cancer by Stage

Staging is ultimately confirmed by surgical removal of the cancer and exploration of the area adjacent to the kidney. The following are simplified definitions of the various stages of renal cell cancer. Click on a stage for an overview of the most recent information available concerning the comprehensive treatment.

Stage I: The primary cancer is 7 centimeters (about 3 inches) or less and is limited to the kidney, with no spread to lymph nodes or distant sites.

Stage II: The primary cancer is greater than 7 centimeters (about 3 inches) and is limited to the kidney, with no spread to lymph nodes or distant sites.

Stage III: The cancer has spread to the regional lymph nodes but not to distant sites in the body, and/or extends to the renal veins or vena cava (large vein returning blood to the heart located in the middle of the abdomen near the back).

Stage IV: The cancer has spread to distant sites or invades directly beyond the local area.

Recurrent Renal Cell Cancer: Renal cell cancer has returned after primary treatment.

References


1 Flanigan RC, Salmon SE, Blumenstein BA et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. New England Journal of Medicine. 2001;345:1655-9.

2 Fyfe G, Fisher RI, Rosenberg SA, et al. Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. Journal of Clinical Oncology. 1995;13(3):688-696.

3 https://news.bms.com/press-release/corporatefinancial-news/opdivo-nivolumab-demonstrates-superior-three-year-survival-ben

4 http://news.cancerconnect.com/afinitor-effective-against-metastatic-kidney-cancer/