Kidney Cancer: Targeted Therapy

Targeted therapy 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. Targeted therapy medicines work in different ways and cause different side effects.

Targeted therapy uses medicines that target specific parts of some cancer cells. They change the ability of the cancer cells to grow and survive. This can block the growth and spread of cancer cells while limiting damage to healthy cells.

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

Targeted therapy may be given after surgery if there's a high risk that the cancer will come back (recur). Targeted therapy can help lower this risk.

There are different kinds of targeted therapy medicines. They may be given as pills or as an infusion. This means they are put into your bloodstream through an IV (intravenous) line.

Experts are still working on how to best way to use these medicines. They're often used one at a time. If one medicine stops working, another might be tried. These are the types of medicines:

• Tyrosine kinase inhibitors. Some kidney cancer cells are controlled by proteins that help them grow. These proteins are called tyrosine kinases. Some targeted therapies block these proteins so cancer cell growth slows or stops.
• Angiogenesis inhibitors. Kidney cancer cells also make a protein that helps the growth of new blood vessels. Growth of new blood vessels is called angiogenesis. These blood vessels bring nutrients to the cancer cells so they can grow and divide. Stopping new blood vessels from forming can stop tumors from growing.

These are the most common targeted therapy medicines for kidney cancer:

• Axitinib (pill)
• Belzutifan (pill)
• Bevacizumab (IV infusion)
• Cabozantinib (pill)
• Everolimus (pill)
• Lenvatinib (pill)
• Pazopanib (pill)
• Sorafenib (pill)
• Sunitinib (pill)
• Temsirolimus (IV infusion)
• Tivozanib (pill)

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.

Side effects of targeted therapy can include:

• Appetite loss
• Changes in cholesterol levels
• Changes in skin or hair color
• Constipation
• Cough
• Diarrhea
• Feeling dizzy
• Feeling tired (fatigue)
• Fluid buildup in the face or legs
• Headaches
• Increased risk of infections
• Joint or muscle pain
• Mouth sores
• Nausea and vomiting
• Pain, redness, swelling, and blistering on palms of hands and soles of feet (hand-foot syndrome)
• Shortness of breath
• Skin rash
• Voice changes
• Weakness
• Weight loss

Serious side effects can include:

• Bleeding
• Heart problems
• High blood pressure
• High blood sugar
• Liver function problems
• Low blood pressure
• Low oxygen levels in the body
• Low thyroid hormone levels
• Low white and red blood cell counts
• Severe diarrhea
• Slow wound healing

Severe side effects can include:

• Bleeding and holes in the intestines
• Blood clots
• Congestive heart failure
• Lung damage
• Heart rhythm problems
• Severe bleeding
• Severe high blood pressure
• Severe liver damage
• Very low red blood cell counts (severe anemia)

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 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.