Kidney Cancer: Immunotherapy

Immunotherapy is a treatment that use medicines to kill cancer cells or slow their growth. It’s not the same as chemotherapy (chemo). Chemo does not work well for kidney cancer. Immunotherapy medicines work in different ways and cause different side effects.

Immunotherapy is also called biologic therapy. This cancer treatment works with your body’s own immune system to find and kill cancer cells. These medicines boost, focus, or restore certain parts of the immune system.

Your healthcare provider may advise this treatment if the cancer has spread beyond your kidney or comes back after treatment.

There are different kinds of immunotherapy medicines used for kidney cancer. They may be given as shots (injections) or as an infusion. This means they are put into your bloodstream through an IV (intravenous) line.

There are 2 main types of immunotherapy medicines used for kidney cancer are: immune checkpoint inhibitors and cytokines.

These medicines help your immune system find and kill cancer cells. Sometimes kidney cancer cells use certain proteins to keep your immune system from attacking them. These proteins are called checkpoints. Medicines that block these checkpoints can boost your immune system against these cancer cells. This can shrink some tumors or slow their growth.

Immune checkpoint inhibitors used for kidney cancer include:

• Avelumab
• Ipilimumab
• Nivolumab
• Pembrolizumab

All of these are given as IV infusions every 2, 3, or 4 weeks.

Cytokines are proteins the body makes to help boost the immune system. Versions of these proteins that are made in a lab can be used to treat kidney cancer. They act like the natural proteins to turn on the immune system. They might be used if other immunotherapy medicines don't work.

Cytokines include:

• Interleukin-2 (IL-2). This medicine given as an IV infusion. Low doses may be given as outpatient therapy, but high doses work better. High-dose IL-2 can cause serious side effects. It's only given at cancer centers that have a lot of experience with this treatment.
• Interferon alfa. This medicine doesn't work as well as IL-2. It's most often given along with another medicine called bevacizumab. It's common to take interferon alfa for many years. This can be done as long as it's working and the side effects aren't too severe. It's given as an injection a few times a week. You can get it as an outpatient at a hospital, clinic, or healthcare provider’s office. This means you go home the same day. Or you may learn how to give it to yourself at home.

Most types of cancer treatment can cause side effects. Some can be severe. Side effects depend on the type and dose of medicines you take.

Side effects vary for each person. It's important to tell your treatment team about any side effects you have. Many of them can be treated to keep them from getting worse. They tend to get better over time after treatment ends.

Possible side effects of immunotherapy include:

• Appetite loss
• Constipation
• Cough
• Diarrhea
• Itchy skin
• Joint pain
• Nausea and vomiting
• Shortness of breath
• Skin rash
• Tiredness (fatigue)

Serious side effects can include:

• Changes in mental function
• Fast heartbeat
• High fever and chills
• Low or high blood pressure
• Pain in the belly (abdomen)
• Severe diarrhea

These severe side effects are less common:

• Bleeding in the intestines
• Fluid in the lungs
• Heart attack
• Kidney damage
• Trouble breathing

In rare cases, some of these side effects can cause death. Because of the risk of severe side effects, these treatments are not an option for everyone. They're used to treat kidney cancer only in people who are otherwise in good overall health and can cope with side effects.

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Ask your healthcare providers what symptoms to watch for. Ask when to call them. For example, many of these medicines can cause diarrhea. You may be told to drink a lot of fluids, not eat high-fiber foods, and call if you have 4 or more loose bowel movements a day for more than 2 days.

Make sure you know what number to call with questions or problems. Ask if there is a different number to call after hours when the clinic is closed.

It may help to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will make it easier for you to work with your healthcare team to make a plan to manage your side effects.