Treatment options for Recurrent Kidney Cancer
Overview
Recurrent kidney cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back many years after initial treatment, in the kidney or in other parts of the body, such as the lungs or bones.
Recurrent renal cell cancers are typically treated with systemic therapy, and local therapy in some cases. Systemic therapy refers to whole-body therapy, includes targeted therapies such as Sutent® (sunitinib), Nexavar® (sorafenib), and Torisel® (temsirolimus). In addition, some patients may benefit from local therapy consisting of surgery to remove metastatic cancer areas.
The following is a general overview of conventional and investigative treatments (In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment.) for recurrent kidney cancer. Cancer treatment includes surgery, targeted therapies and a combination of these treatment techniques. Combining two or more of these treatment techniques has become an important approach for increasing a patient’s survival rate and chance of cure.
Circumstances vary from patient to patient so treatment or treatments are different. The potential benefits of combination treatment, join a clinical trial or standard treatment must be carefully balanced with the potential risks. The information on this Web site is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their physicians.
Immunotherapy for Recurrent Renal Cell Cancer
Immunotherapy works by stimulating the immune system to fight the cancer. The two most frequently used drugs of immunotherapy are Proleukin® (interleukin-2) and interferon alfa.
Proleukin® (interleukin-2): IL-2 was the standard treatment for kidney cancer patients before the FDA-approval of new targeted therapies. It is typically administered in high doses as an inpatient treatment and has historically been associated with severe side effects. However, the safety of high-dose Proleukin has significantly improved over the past ten years. Unfortunately, long-term results of clinical trials show that only about 15% of patients with advanced renal cell carcinoma have an anticancer response when treated with high-dose IL-2. For this reason the combination of targeted therapy plus IL-2 is being evaluated in clinical trials.
One site of cancer spread in metastatic renal cell cancer is the lungs. Administering interleukin-2 as a spray that is inhaled into the lungs has been shown to stabilize cancer progression in patients with lung metastases from renal cell cancer. More than half of patients treated with inhaled interleukin-2 had stable disease. On average, patients were free of cancer progression for nearly nine months after treatment.
Thalidomide plus interleukin-2: Thalidomide has been shown to cause anticancer effects in several ways, including preventing or reducing the production of blood vessels that serve the cancer cells, thereby starving the cancer of the nutrients and oxygen they need to survive and grow. As initial treatment for metastatic renal cell cancer, the combination of thalidomide plus interleukin-2 has been shown to partially shrink cancer in approximately one-quarter of patients and stabilize disease in 15% of patients. Researchers continue to evaluate thalidomide in the treatment for renal cell cancer.
Interferon: Interferon is naturally produced in the body and stimulates the immune system. Interferon alfa is a compound produced in a laboratory that simulates the action of natural interferon to stimulate the immune system to recognize and destroy some types of cancer cells.
Treatment of renal cell carcinoma with interferon alfa appears to produce anticancer responses in less than 15% of patients with advanced renal cell cancer. Because side effects can be severe and it has not been shown to improve survival, the use of interferon alone in the treatment of renal cell carcinoma is not recommended.
Targeted Therapy for Recurrent Renal Cell Cancer
A targeted therapy is one that is designed to treat only the cancer cells and minimize damage to normal, healthy cells. The advantages of cancer treatments that “target” cancer cells may include reduced treatment-related side effects and improved outcomes.
There are many targeted drugs have been approved by FDA for advanced renal cell cancer treatment.
Votrient (pazopanib) (2009)
Afinitor (everolimus) (2009)
Avastin (bevacizumab) with Interferon Alpha-2a (IFN) (2009)
Torisel (temsirolimus) (2007)
Sutent (sunitinib) (2006)
Latest drug treatments in metastasized Kidney Cancer (mRCC)
Chemotherapy for Recurrent Renal Cell Cancer
Cancer chemotherapy may consist of single drugs or combinations of drugs to destroy cancer cells by impeding their growth and reproduction, and can be administered through a vein or delivered orally in the form of a pill. Chemotherapy is not a standard treatment for kidney cancer, kidney cancers have resistance to chemotherapy. Usually chemotherapy is used as a neoadjuvant treatment or as a palliative treatment for kidney cancer. (Detail…)
Radiation Therapy for Recurrent Renal Cell Cancer
Recurrent renal cell cancers may be treated with radiation therapy to relieve the symptoms such as pain or bleeding. Renal cell cancers are resistant to radiation therapy, which means that this approach will not eliminate the cancer, but it may temporarily slow its growth and relieve associated discomforts. (Detail…)
Surgery for Renal Cell Cancer
Some patients with recurrent renal cell cancer may benefit from surgery. Results of a clinical trial indicate that renal cell cancer that has spread to the lungs can be removed with surgery. Among patients with lung metastases but no evidence of cancer elsewhere in the body, including the kidney, nearly 40% survived five years or more after undergoing surgery for the lung metastases. Patients with only a single site of cancer in the lung experienced the best outcomes. (Detail…)
Combination Therapy
Combinations of targeted therapy, chemotherapy and other treatments may produce more anticancer responses and improve the outcomes of patients with advanced renal cell cancer than treatment with any single therapy. Combination therapy can take advantage of potential drug synergies and non overlapping side effects to improve clinical benefit.
Vaccines for Renal Cell Cancer
Vaccines are comprised of proteins that stimulate the immune system to destroy foreign substances in the body, such as bacteria. Vaccines are also being developed that stimulate the immune system to recognize cancer cells as harmful and destroy them. Cancer vaccines are typically made from proteins that are more abundantly present on cancer cells than normal cells. The patient’s own cancer cells are often used to make the vaccine, which is one reason that vaccines may be difficult to prepare. The patient’s cancer cells must be processed immediately following surgery.
A vaccine comprised of cells from the patient’s cancer has been shown to improve progression-free survival compared with surgery alone in the treatment of patients with renal cell cancer. Nearly three-quarters of the patients treated with the vaccine survived approximately six years or more compared with 59% of those treated with surgery alone. This research is ongoing. (More…)
