Treatment Options for Metastatic and Recurrent Renal Cell Carcinoma

When the kidney cancer known as renal cell carcinoma spreads to other places (metastatic) or comes back after remission (recurrent), you may need different types of treatment.

“Most patients with advanced RCC will still live for years,” he says.

Immunotherapy

Immunotherapy medications help your immune system slow cancer growth. They are the first line of treatment when RCC has spread beyond where surgery and radiation can make an impact, Ornstein says.

For RCC, doctors use a type of immunotherapy called checkpoint inhibitors, which “release the brakes” on checkpoint molecules, allowing your body to attack cancer cells more vigorously, Ornstein says. Depending on your RCC type, you could take two immunotherapy drugs together or one plus another type of cancer-fighting medication, he says.

• avelumab (Bavencio)
• interferon
• interleukin-2 (Proleukin)
• ipilimumab (Yervoy)
• nivolumab (Opdivo)
• pembrolizumab (Keytruda)

• Cough
• Nausea
• Poor appetite
• Itching and skin rash
• Constipation
• Diarrhea
• Joint pain
• Fatigue

If you experience side effects, talk to your doctor about how to manage them or potential adjustments to your treatment.

Targeted Therapy

Targeted therapy drugs such as tyrosine kinase inhibitors destroy RCC cells by cutting off their blood supply, Ornstein says. Other types stop the cancer from growing by targeting specific proteins.

“Targeted therapies might be useful when more urgent control of the tumor is needed,” says Dr. Braun, while immunotherapy is used for longer periods when there is less urgency.

• axitinib (Inlyta)
• belzutifan (Welireg)

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• bevacizumab (Avastin)
• cabozantinib (Cabometyx)
• everolimus (Afinitor)
• lenvatinib (Lenvima)
• pazopanib (Votrient)
• sorafenib (Nexavar)
• sunitinib (Sutent)
• temsirolimus (Torisel)
• tivozanib (Fotivda)

• Nausea
• Poor appetite
• Diarrhea
• Skin or hair color changes
• Hand-foot syndrome, a skin reaction that causes redness, swelling, numbness, or blistering of the hands and feet
• High blood pressure
• Pain in your joints or muscles
• Headaches
• Mouth sores
• Higher risk of infection
• Fluid buildup
• Fatigue and weakness
• Anemia

One type of targeted therapy called vascular endothelial growth factor (VEGF) pathway inhibitors can increase your risk of heart problems, cause kidney issues, and slow wound healing, says Jack Melson, MD, a medical oncologist at VCU Massey Comprehensive Cancer Center in Richmond, Virginia.

Surgery and Radiation Therapy

• Arterial Embolization A surgeon inserts a thin tube through the blood vessel that goes to your kidney and blocks blood flow to the tumor to shrink it.
• Cryosurgery Your doctor freezes the tumor using a specialized tool.
• Thermal Ablation (Hyperthermia) Instead of cold, this procedure uses heat to destroy cancer cells.
• External Beam Radiation Therapy A machine sends targeted radiation into your body to reach the tumor area.

Braun says that he may recommend surgery or radiation alongside medications in the following situations.

• Only a few tumor spots are visible on imaging scans.
• Tumors cause symptoms such as pain.
• Only one cancerous area is growing.

After these procedures treat or remove the tumors in your kidney or anywhere they have spread, your doctor will schedule regular CT scans to check for any returning growth, Ornstein says.

Clinical Trials

Experts continue to search for better ways to treat metastatic and recurrent RCC, and you could be eligible to join a clinical trial to test new medications and treatment options.

“There have been dramatic improvements in the outcomes of patients with metastatic RCC,” Ornstein says. “This has only been possible with clinical trials that have moved the field forward.”

You can look for recruiting trials on the ClinicalTrials.gov website. If you spot one, talk to your doctor, who can also point you toward trials for emerging treatments.

“I would encourage patients to ask their oncologist if there are clinical trial options available to them,” Dr. Melson says.

The Takeaway

• Metastatic and recurrent renal cell carcinoma (RCC) may require various forms of treatment to address cancer that has spread beyond the kidney or that returns.
• Immunotherapy and targeted therapy medications may be the first options for tackling RCC, depending on your type of RCC and where cancer may reside.
• Surgery and radiation therapy may be necessary to remove cancerous cells, but they are used primarily to relieve symptoms such as pain, bleeding, or organ pressure for metastatic and recurrent RCC.
• Talk to your doctor about clinical trials for emerging medications or new ways to identify RCC.